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FAT  AND  BLOOD: 


AN  ESSAY 


TREATMENT  OF  CEKTAIK  POEMS  OF 


NEURASTHENIA  AND  HYSTERIA. 


BY 


S.  WEIR   MITCHELL,  M.D., 

111 


MEMBER  OF  THE  NATIONAL  ACADEM'if  OF  SCIENCES;  PHYSICIAN  TO  THE  ORTHOPCEDIC 


HOSPITAL    AND    INFIRMARY    FOR    DISEASES  OF  THE  NERVOUS    SYSTEM  ;    VICE- 
PRESIDENT  OF  THE  PHILADELPHIA  COLLEGE  OF  PHYSICIANS  ;  HONORARY 
CORRESPONDING   MEMBER    OF   THE    BRITISH    MEDICAL   ASSOCIA- 
TION ;      HONORARY'    MEMBER    OF    THE     LONDON    MEDICAL 
SOCIETY ;      FOREIGN     ASSOCIATE     OF     THE    ROYAL 
MEDICAL   SOCIETY    OF   NORWAY,   ETC. 


FOURTH  EDITION,  REVISED,  WITH  ADDITIONS. 


P  H  I  li  A  D  E  L  P  H  I  A  : 

J.  B.  LIPPINCOTT   COMPANY. 
LONDON:  15  RUSSELL  STREET,  COVENT  GARDEN. 

1885. 


Copyright,  1877,  by  J.  B.  Lippincott  k  Co. 


Copyright,  1883,  by  J.  B.  Lippincott  &  Co. 


TO 

SAMUEL  LEWIS,  M.D.  EDIN.,  M.KC.S.  LOND., 

EX-PRESIDENT  PHILADELPHIA  COLLEGE  OF  PHYSICIANS. 


The  profession  in  Philadelphia  owes  chiefly  to 
your  unceasing  liberality  the  great  library  of  our 
College  of  Physicians.  Personally,  I  owe  to  you  a 
friendship  which  the  passing  years  have  made  more 
valuable.  As  a  physician  and  a  friend,  therefore, 
I  gratefully  dedicate  to  you  the  fourth  edition  of 
this  little  book. 

THE   AUTHOE. 


CONTENTS. 


CHAPTEE    I. 

PAGE 

Introductoky 7 


CHAPTER    II. 
Gain  or  Loss  of  Weight  Clinically  Considered      14 

CHAPTEE    III. 

On  the  Selection  of  Cases  for  Treatment  .        .      33 

CHAPTEE    IV. 
Seclusion 47 

CHAPTEE   V. 
Eest .        .      52 

CHAPTEE    VI. 
Massage .        .        .        .      71 

CHAPTEE    VII. 
Electricity 86 

CHAPTEE    Vlil. 
Dietetics  and  Therapeutics 97 

Index 168 

1*  5 


PREFACE  TO  THE  FOUETH  EDITION. 


I  HAVE  made  some  slight  changes  in  this  edi- 
tion, and  have  added  a  few  not  unimportant 
points  in  regard  to  treatment. 

S.  WEIR  MITCHELL. 


CHAPTER   I. 

INTRODUCTORY. 

For  some  years  I  have  been  using  with  suc- 
cess, in  private  and  in  hospital  practice,  certain 
methods  of  renewing  the  vitality  of  feeble  people 
by  a  combination  of  entire  rest  and  of  excessive 
feeding,  made  possible  by  passive  exercise  ob- 
tained through  the  steady  use  of  massage  and 
electricity. 

The  cases  thus  treated  have  been  chiefly  women 
of  a  class  well  known  to  every  physician, — ner- 
vous women,  who,  as  a  rule,  are  thin  and  lack 
blood.  Most  of  them  have  been  such  as  had 
passed  through  many  hands  and  been  treated  in 
turn  for  gastric,  spinal,  or  uteriB£_ troubles,  but 
who  remained  at  the  end  as  at  the  beginning,  in- 
valids, unable  to  attend  to  the  duties_of^ife,  and 
sources  alike  of  discomfort  to  themselves  and 
anxiety  to  others. 

In  1875  I  published  in  "  Seguin's  Series  of 
American  Clinical  Lectures,"  Yol.  I.,  ^o.  iv.,  a 


10  JNTR  OD  UCTOR  V. 

brief  sketch  of  this  treatment,  under  the  heading 
of  "  Rest  in  the  Treatment  of  Nervous  Disease," 
but  the  scope  afforded  me  was  too  brief  for  the 
details  on  a  knowledge  of  which  depends  success 
in  the  use  of  rest.  I  have  been  often  since  re- 
minded of  this  by  the  many  letters  I  have 
received  asking  for  explanations  of  the  minutiae 
of  treatment ;  and  this  must  be  my  apology  for 
bringing  into  these  pages  a  great  many  particu- 
lars which  are  no  doubt  well  enough  known  to 
the  more  accomplished  physician. 

In  the  preface  to  the  second  edition  I  said 
that  as  yet  there  had  been  hardly  time  for  a 
competent  verdict  on  the  methods  I  had  de- 
scribed. Since  making  this  statement,  many 
of  our  profession  in  America  have  published 
cases  of  the  use  of  my  treatment.  It  has  also 
been  thoroughly  discussed  by  the  medical  sec- 
tion of  the  British  Medical  Association,  and 
warmly  endorsed  by  William  Playfair,  of  Lon- 
don, Ross,  of  Manchester,  Coghill,  and  others; 
while  a  translation  of  my  book  into  French  by 
Dr.  Oscar  Jennings,  with  an  introduction  by 
Professor  Ball,  has  placed  it  satisfactorily  before 
the  profession  in  France. 

As  regards  the  question  of  originality  I  did 


INTRODUCTORY.  H 

not  and  do  not  now  much  concern  myself.  This 
alone  I  care  to  know,  that  by  the  method  in 
question  cases  are  cured  which  once  were  not ; 
and  as  to  the  novelty  of  the  matter  it  would  be 
needless  to  say  more,  were  it  not  that  the  charge 
of  lack  of  that  quality  is  sometimes  taken  as  an 
imputation  on  a  man's  good  faith. 

But  to  sustain  so  grave  an  implication  the 
author  must  have  somewhere  laid  claim  to  ori- 
ginality and  said  in  what  respect  he  considered 
himself  to  hav-e  done  a  totally  new  thing.  The 
following  passage  from  the  first  edition  of  this 
book  explains  what  was  my  own  position  : 

"  I  do  not  wish,"  I  wrote,  "  to  be  thought  of 
as  putting  forth  anything  very  remarkable  or 
original  in  my  treatment  by  rest,  systematic 
feeding,  and  passive  exercise.  All  of  these  have 
been  used  by  physicians ;  but,  as  a  rule,  one  or 
more  are  used  without  the  others,  and  the  plan 
which  I  have  found  so  valuable,  of  combining 
these  means,  does  not  seem  to  be  generally  un- 
derstood. As  it  involves  some  novelty,  and  as 
I  do  not  find  it  described  elsewhere,  I  shall,  I 
think,  be  doing  a  service  to  my  profession  by 
relating  my  experience." 

The   following   quotation   from   Dr.   William 


1 2  INTROD  UCTOR  F. 

Plajfair's  essay  ^  says  all  that  I  would  care  to 
add : 

"  The  claims  of  Dr.  "Weir  Mitchell  to  origi- 
nality in  the  introduction  of  this  system  of  treat- 
ment, which  I  have  recently  heard  contested  in 
more  than  one  quarter,  it  is  not  my  province  to 
defend.  I  feel  bound,  however,  to  say  that, 
having  carefully  studied  what  has  been  written 
on  the  subject,  I  can  nowhere  find  anything  in 
the  least  approaching  to  the  regular,  systematic, 
and  thorough  attack  on  the  disease  here  dis- 
cussed. 

"  Certain  parts  of  the  treatment  have  been 
separately  advised,  and  more  or  less  successfully 
practised,  as,  for  example,  massage  and  electri- 
city, without  isolation  ;  or  isolation  and  judicious 
moral  management  alone.  It  is,  in  fact,  the  old 
story  with  regard  to  all  new  things  :  there. is  no 
discovery,  from  the  steam-engine  down  to  chloro- 
form, which  cannot  be  shown  to  have  been  par- 
tially foreseen,  and  yet  the  claims  of  Watt  and 
Simpson  to  originality  remain  practically  un- 
contested.     And  so,  if  I  may  be  permitted  to 


*  The  Systematic  Treatment  of  Nerve  Prostration  and  Hys- 
toriti.     London,  1883. 


INTRODUCTORY,  13 

compare  small  things  witli  great,  will  it  be  with, 
this.  The  whole  matter  was  admirably  summed 
up  by  Dr.  Ross,  of  Manchester,  in  his  remarks  in 
the  discussion  I  introduced  at  the  meeting  of  the 
British  Medical  Association  at  Worcester,  which 
I  conceive  to  express  the  precise  state  of  the  case: 
'  Although  Dr.  Mitchell's  treatment  was  not  new 
in  the  sense  that  its  separate  recommendations 
were  made  for  the  first  time,  it  was  new  in  the 
sense  that  these  recommendations  were  for  the 
first  time  combined  so  as  to  form  a  complete 
scheme  of  treatment.' '' 

As  regards  the  acceptance  of  this  method  of 
treatment  I  have  to-day  no  complaint  to  make. 
It  runs,  indeed,  the  risk  of  being  employed  in 
cases  which  do  not  need  it  and  by  persons  who 
are  not  competent,  and  of  being  thus  in  a  measure 
brought  into  disrepute.  As  concerns  one  of  its 
essentials  —  massage  —  this  is  especially  to  be 
feared.  It  is  a  remedy  with  capacity  to  hurt  as 
well  as  to  help,  and  should  never  be  used  with- 
out the  advice  of  a  physician,  nor  persistently 
kept  up  without  medical  observation  of  its 
temporary  and  more  permanent  effects. 


CHAPTEE    11. 

GAIN    OR   LOSS    OF   WEIGHT   CLINICALLY  CONSIDERED. 

The  gentlemen  who  have  done  me  the  honor 
to  follow  my  clinical  service  at  the  State  Infirm- 
ary for  Diseases  of  the  I'Tervous  System  ^  are  well 
aware  how  much  care  is  there  given  to  learn 
whether  or  not  the  patient  is  losing  or  has  lost 
flesh,  is  by  habit  thin  or  fat.  This  question  is 
one  of  the  utmost  moment  in  every  point  of 
view,  and  deserves  a  larger  share  of  attention 
than  it  receives.  In  this  hospital  it  is  the  cus- 
tom to  weigh  our  cases  when  they  enter  and  at 
intervals.  The  mere  loss  of  fat  is  probably  of 
small  moment  in  itself  when  the  amount  of  re- 
storative food  is  sufficient  for  every-day  expendi- 
ture, and  when  the  organs  are  in  condition  to 
keep  up  the  supply  of  fat  which  we  not  only 
require  for  constant  use  but  probably  need  to 


^  The  Pennsylvania  Orthopaedic  Hospital  and  Infirmary  for 

Diseases  of  the  Nervous  System. 
14 


GAIN  OR  LOSS  OF    WEIGHT.  I5 

change  continually.  The  steady  or  rapid  lessen- 
ing of  the  deposits  of  hydro-carbons  stored  away 
in  the  areolae  of  the  tissues  is  of  importance, 
as  indicating  their  excessive  use  or  a  failure  of 
supply ;  and  when  either  condition  is  to  be  sus- 
pected it  becomes  our  duty  to  learn  the  reasons 
for  this  striking  symptom.  Loss  of  flesh  has 
also  a  collateral  value  of  great  import,  because 
it  is  almost  an  invariable  rule  that  rapid  thin- 
ning is  accompanied  soon  or  late  with  more  or 
less  anaemia,  and  it  is  uncommon  to  see  a  person 
steadily  gaining  fat  after  any  pathological  reduc- 
tion of  weight  without  a  corresponding  gain  in 
amount  and  quality  of  blood.  We  too  rarely 
reflect  that  the  blood  thins  with  the  decrease  of 
the  tissues  and  enriches  as  they  increase. 

Before  entering  into  this  question  further,  I 
shall  ask  attention  to  some  points  connected  with 
the  normal  fat  of  the  human  body;  and,  taking, 
for  granted,  here  and  elsewhere,  that  my  readers 
are  well  enough  aware  of  the  physiological  value 
and  uses  of  the  adipose  tissues,  I  shall  continue 
to  look  at  the  matter  chiefly  from  a  clinical  point 
of  view. 

When  in  any  individual  the  weight  varies  rap- 
idly or  slowly,  it  is  nearly  always  due,  for  the 


J 


16  QAIB  OR  LOSS  OF    WEIGHT. 

most  part,  to  a  change  in  tlie  amount  of  adipose 
tissue  stored  away  in  the  meshes  of  the  areolar 
tissue.  Almost  any  grave  change  for  the  worse 
in  health  is  at  once  betrayed  in  most  people  by  a 
diminution  of  fat,  and  this  is  readily  seen  in  the 
altered  forms  of  the  face,  which,  because  it  is  the 
always  visible  and  in  outline  the  most  irregular 
part  of  the  body,  shows  first  and  most  plainly  the 
loss  or  gain  of  tissue.  Fatty  matter  is  therefore 
that  constituent  of  the  body  which  goes  and 
comes  most  easily.  Why  there  is  in  nearly  every 
one  a  normal  limit  to  its  accumulation  we  cannot 
say,  nor  yet  why  this  limit  should  vary  as  life 
goes  on.  Even  in  health  the  weight  of  men,  and 
still  more  of  v^omen,  is  by  no  means  constant, 
but,  as  a  rule,  when  we  are  holding  our  own  with 
that  share  of  stored-up  fat  which  belongs  to  the 
individual  we  are  usually  in  a  condition  of  nu- 
tritive prosperit}^,  and  when  after  any  strain  or 
trial  which  has  lessened  weight  we  are  slowly  re- 
pairing mischief  and  laying  by  fat  we  are  equally 
in  a  state  of  health.  The  loss  of  fat  which  is 
not  due  to  change  of  diet  or  to  exercise,  espe- 
cially its  rapid  or  steady  loss,  nearly  always  goes 
along  with  conditions  which  impoverish  the 
blood,  and,  on  the  other  hand,  the  gain  of  fat 


GAIN   OR  LOSS  OF   WEIGHT,  17 

up  to  a  certain  point  seems  to  go  hand  in  hand 
with  a  rise  in  all  other  essentials  of  health,  and 
notably  with  an  improvement  in  the  color  and 
amount  of  the  red  corpuscles. 

The  quantity  of  fat  which  is  healthy  for  the 
individual  varies  with  the  sex,  the  climate,  the 
habits,  the  season,  the  time  of  life,  the  race,  and 
the  breed.  Quetelet^  has  shown  that  before  pu- 
berty the  weight  of  the  male  is  for  equal  ages 
above  that  of  the  female,  but  that  towards  pu- 
berty the  proportional  weight  of  the  female,  due 
chiefly  -to  gain  in  fat,  increases,  so  that  at  twelve 
the  two  sexes  are  alike  in  this  respect.  During 
the  child-bearing  time  there  is  an  absolute  less- 
ening on  the  part  of  the  female,  but  after  this 
time  the  weight  of  the  woman  increases,  and  the 
maximum  is  attained  at  about  the  age  of  fifty. 

Dr.  Henry  I.  Bowditch^  reaches  somewhat 
similar  conclusions,  and  shows  from  much  more 
numerous  measurements  of  Boston  children  that 
growing  boys  are  heavier  in  proportion  to  their 
height  than  girls  until  they  reach  fifty-eight 
inches,  which  is  attained  about  the  fourteenth 


1  Sur  rHomme,  p.  47,  et  seq. 

2  Growth  of  Children,  p.  31. 


18  GAIN  OR   LOSS  OF    WEIGHT. 

year.  Then  the  girl  passes  the  boy  in  weight, 
which  Dr.  Bowclitch  thinks  is  due  to  the  accu- 
mulation of  adipose  tissue  at  puberty.  After 
two  or  three  years  more  the  male  again  acquires 
and  retains  superiority  in  weight  and  height. 

Yet  as  life  advances  there  are  peculiarities 
which  belong  to  individuals  and  to  families.  One 
group  thins  as  life  goes  on  past  forty ;  another 
group  as  surely  takes  on  flesh ;  and  the  same 
traits  are  often  inherited,  and  are  to  be  regarded 
when  the  question  of  fattening  becomes  of  clini- 
cal or  diagnostic  moment.  Men,  as  a  rule,  pre- 
serve their  nutritive  status  more  equably  than 
women.  Every  physician  must  have  been  struck 
with  this.  In  fact,  many  women  lose  or  acquire 
large  amounts  of  adipose  matter  without  any 
corresponding  loss  or  gain  in  vigor,  and  this  fact 
perhaps  is  related  in  some  way  to  the  enormous 
outside  demands  made  by  their  peculiar  physi- 
ological processes.  Such  gain  in  weight  is  a 
common  accompaniment  of  child-bearing,  while 
nursing  in  some  women  involves  considerable 
gain  in  flesh,  and  in  a  larger  number  enormous 
falling  away,  and  its  cessation  as  speedy  a  re- 
newal of  fat.  I  have  also  found  that  in  many 
women  who   are  not  perfectly  well  there  is  a 


GAIN  OR  LOSS  OF   WEIGHT.  19^ 

notable  loss  of  weight  at  every  menstrual  period, 
and  a  marked  o^ain  between  these  times.  — - 

I  was  disappointed  not  to  find  this  matter 
dealt  with  fully  in  Mrs.  Jacobi's  able  essay  on 
menstruation,  nor  can  I  discover  elsewhere  any 
observations  in  regard  to  loss  or  gain  of  weight 
at  menstrual  periods  in  the  healthy  woman. 

How  much  influence  the  seasons  have,  is  not 
as  yet  well  understood,  but  in  our  own  climate, 
with  its  great  extremes,  there  are  some  inter- 
esting facts  in  this  connection.  The  upper 
classes  are  with  us  in  summer  placed  in  the  best 
conditions  for  increase  in  flesh,  not  only  because  it 
is  their  season  of  least  work,  mental  and  physical, 
but  also  because  they  are  then  for  the  most  part 
living  in  the  country  under  circumstances  favor- 
able to  appetite,  to  exercise,  and  to  freedom  from 
care.  Owing  to  these  fortunate  facts,  members 
of  the  class  in  question  are  apt  to  gain  weight  in 
summer,  although  many  such  persons,  as  I  know, 
follow  the  more  general  rule  and  lose  weight. 
But  if  we  deal  with  the  mass  of  men  who  are 
hard  worked,  physically,  and  unable  to  leave  the 
towns,  we  shall  probably  find  that  they  nearly 
always  lose  weight  in  hot  weather.  Some  support 
is  given  to  this  idea  by  the  following  very  curi- 


20  GAIN  OR  LOSS  OF   WEIGHT. 

ous  facts.  Yerj  many  years  ago  I  was  engaged 
for  certain  purposes  in  determining  the  weight, 
height,  and  girth  of  all  the  members  of  our  city 
police  force.  The  examination  was  made  in 
April  and  repeated  in  the  beginning  of  October. 
Every  care  w^as  taken  to  avoid  errors,  but  to  my 
surprise  I  found  that  a  large  majority  of  the 
men  had  lost  weight  during  the  summer.  The 
sum  total  of  loss  was  enormous.  As  I  have  mis- 
laid some  of  the  sheets,  I  am  unable  to  give  it 
accurately,  but  I  found  that  three  out  of  every 
^YQ  had  lessened  in  weight.  It  would  be  inter- 
esting to  know  if  such  a  change  occurs  in  con- 
victs confined  in  penitentiaries. 

I  am  acquainted  with  some  persons  who  lose 
weight  in  winter,  and  with  more  who  fail  in 
flesh  in  the  spring,  which  is  our  season  of  great- 
est depression  in  health, — the  season  when  with 
us  choreas  are  apt  to  originate^  or  to  recur,  and 
when  habitual  epileptic  fits  become  more  frequent 
in  such  as  are  the  victims  of  that  disease. 

Climate  has  a  good  deal  to  do  with  a  tendency 

*  See  a  valuable  paper  by  Dr.  Gerhard,  Am.  Jour.  Med. 
Sci.,  1876.  Also  Lectures  on  Diseases  of  the  Nervous  System, 
especially  in  Women.  S.  Weir  Mitchell.  Phila.,  1881,  p. 
127. 


GAIN  OR  LOSS  OF    WEIGHT.  21 

to  take  on  fat,  and  I  think  the  first  thing  which 
strikes  an  American  in  England  is  the  numhe} 
of  inordinately  fat  middle-aged  people,  and  es- 
pecially of  fat  women. 

This  excess  of  flesh  we  usually  associate  in 
idea  with  slothfulness,  hut  English  women  ex- 
ercise more  than  ours,  and  live  in  a  land  where 
few  days  forbid  it,  so  that  probably  such  a  ten- 
dency to  obesity  is  due  chiefly  to  climatic  causes. 
To  these  latter  also  we  may  no  doubt  ascribe  the 
habits  of  the  English  as  to  food.  They  are  larger 
feeders  than  we,  and  both  sexes  consume  strong 
beer  in  a  manner  which  would  in  this  country 
be  destructive  of  health.  These  habits  aid,  I 
suspect,  in  producing  the  more  general  fatness 
in  middle  and  later  life,  and  those  enormous 
occasional  growths  which  so  amaze  an  American 
when  first  he  sets  foot  in  London.  But,  what- 
ever be  the  cause,  it  is  probable  that  members 
of  the  prosperous  classes  of  English,  over  forty, 
would  outweigh  the  average  American  of  equal 
height  of  that  period,  and  this  must  make,  I 
should  think,  some  difierence  in  their  relative 
liability  to  certain  forms  of  disease,  because  the 
overweisrht  of  our  trans-Atlantic  cousins  is 
plainly  due  to  excess  of  fat. 


22  GAIN  OR  LOSS   OF   WEIGHT. 

I  have  sought  in  vain  for  English  tables  giving 
the  weight  of  men  and  women  of  various  heights 
at  like  ages.  The  material  for  such  a  study  of 
men  in  America  is  given  in  Gould's  researches 
published  by  the  United  States  Sanitary  Com- 
mission, and  in  Baxter's  admirable  report/  bul 
is  lacking  for  women.  A  comparison  of  these 
points  as  between  English  and  Americans  of 
both  sexes  would  be  of  great  interest. 

I  doubt  whether  in  this  country  as  notable  a 
growth  in  bulk  as  multitudes  of  English  attain 
Avould  be  either  healthy  or  desirable  in  point 
of  comfort,  owing  to  the  distress  which  stout 
people  feel  in  our  hot  summer  weather.  Cer- 
tainly "  Banting"  is  with  us  a  rarely-needed 
process,  and,  as  a  rule,  we  have  much  more  fre- 
quent occasion  to  fatten  than  to  thin  our  patients. 
The  climatic  peculiarities  which  have  changed 
our  voices,  sharpened  our  features,  and  made 
small  the  American  hand  and  foot,  have  also 
made  us,  in  middle  and  advanced  life,  a  thinner 
and  more  sallow  race,  and,  possibly,  adapted  us 
better  to  the  region  in  which  we  live.     The  same 

*  Statistics  (Anthropological)  Surgeon-General's  Bureau — 
1875. 


GAIN  OR  LOSS   OF    WEIGHT.  23 

changes  in  form  are  in  like  manner  showing 
themselves  in  the  English  race  in  Australia.^ 

Some  gain  in  flesh  as  life  goes  on  is  a  frequent 
thing  here  as  elsewhere,  and  usually  has  no  un- 
wholesome meaning.  Occasionally  we  see  people 
past  the  age  of  sixty  suddenly  taking  on  fat  and 
becoming  at  once  unwieldy  and  feeble,  the  fat 
collecting  in  masses  about  the  belly  and  around 
the  joints.  Such  an  increase  is  sometimes  ac- 
companied with  fatty  degeneration  of  the  heart 
and  muscles,  and  with  a  certain  watery  flabbi- 
ness  in  the  limbs,  which,  however,  do  not  pit 
on  pressure. 

Alcoholism  also  gives  rise  in  some  people  to  a 
vast  increase  of  adipose  tissue,  and  the  sodden, 
unwholesome  fatness  of  the  hard  drinker  is  a 
sufficiently  well  known  and  unpleasant  spectacle. 


^This  excess  of  corpulence  in  the  English  is  attained  chiefly 
after  forty,  as  I  have  said.  The  average  American  is  taller 
than  the  average  Englishman,  and  is  fully  as  well  built  in 
proportion  to  his  height,  as  Gould  has  shown.  The  child  of 
either  sex  in  New  England  is  both  taller  and  heavier  than 
the  English  child  of  corresponding  class  and  age,  as  Dr.  H.  I. 
Bowditch  has  lately  made  clear ;  while  the  English  of  the 
manufacturing  and  agricultural  classes  are  miserably  inferior 
to  the  members  of  a  similar  class  in  America. 


24  GAIN  OR  LOSS  OF   WEIGHT. 

The  overgrowth  of  inert  people  who  do  not  ex- 
ercise enough  to  use  up  a  healthy  amount  of 
overfed  tissues  is  common  enough  as  an  indi- 
vidual peculiarity,  but  there  are  also  two  other 
conditions  in  which  fat  is  apt  to  be  accumulated  to 
an  uncomfortable  extent.    Thus,  in  some  cases  of 
hysteria  where  the  patient  lies  abed  owing  to  her 
belief  that  she  is  unable  to  move  about,  she  is  apt 
in  time  to  become  enormously  stout.    This  seems 
to  me  also  to  be  favored  by  the  large  use  of 
morphia  to  which  such  women  are  prone,  so  that 
I  should  say  that  long  rest,  the  hysterical  consti- 
tution, and  the  accompanying  resort  to  morphia 
make  up  a  group  of  conditions  highly  favorable 
to  increase  of  fat. 

Lastly,  there  is  the  class  of  fat  anaemic  people, 
usually  women.  This  double  peculiarity  is  rather 
uncommon,  but,  as  the  mass  of  thin-blooded  per- 
sons are  as  a  rule  thin  or  losing  flesh,  there  nmst 
be  something  unusual  in  that  anaemia  which  goes 
with  gain  in  flesh. 

Bauer ^  thinks  that  lessened  number  of  blood- 
corpuscles  gives  rise  to  storing  of  fat,  owing  to 

iZeitschrift  fur  Biol.,  1872.  Phila.  Med.  Times,  vol.  iii., 
page  115. 


GAIN  OR  LOSS   OF    WEIGHT.  25 

lessened  tissue -combustion.  At  all  events,  the 
absorption  of  oxygen  diminishes  after  bleeding, 
and  it  used  to  be  well  known  that  some  people 
grew  fat  when  bled  at  intervals.  Also,  it  is  said 
that  cattle-breeders  in  some  localities — certainly 
not  in  this  country — bleed  their  cattle  to  cause 
increase  of  fat  in  the  tissues,  or  of  fat  secreted  as 
butter  in  the  milk.  These  explanations  aid  us 
but  little  to  comprehend  what,  after  all,  is  onl}^ 
met  with  in  certain  persons,  and  must  therefore 
involve  conditions  not  common  to  every  one  who 
is  ansemic.  Meanwhile,  the  group  of  fat  ansemics 
is  of  the  utmost  clinical  interest,  as  I  shall  by 
and  by  point  out  more  distinctly. 

There  is  a  popular  idea,  which  has  probably 
passed  from  the  agriculturist  into  the  common 
mind  of  the  community,  to  the  effect  that  human 
fat  varies, — that  some  fat  is  wholesome  and  some 
unwholesome,  that  there  are  good  fats  and  bad 
fats.  I  remember  well  an  old  nurse  who  assured 
me  when  I  was  a  student  that  "  some  fats  is  fast 
and  some  is  fickle,  but  cod-oil  fat  is  easy  squan- 
dered." 

There  are  more  facts  in  favor  of  some  such 
idea  than  I  have  place  for,  but  as  yet  we  have 
no  distinct  chemical  knowledge  as  to  whether  the 


26  GAIN  OR   LOSS   OF    WEIGHT. 

fats  put  on  under  alcohol  or  morplda,  or  rap- 
idly by  the  use  of  oils,  or  pathologically  in  fatty 
degenerations,  or  in  anaemia,  vary  in  their  con- 
stituents. It  is  not  at  all  unlikely  that  such  is 
the  case,  and  that,  for  example,  the  fat  of  an 
obese  angemic  person  may  differ  from  that  of  a 
fat  and  florid  person.  The  flabby,  relaxed  state 
of  many  fat  people  is  possibly  due  not  alone  to 
peculiarities  of  the  fat,  but  also  to  want  of  tone 
and  tension  in  the  areolar  tissues,  which,  from 
all  that  we  now  know  of  them,  may  be  capable 
of  undergoing  changes  as  marked  as  those  of 
muscles. 

That,  however,  animals  may  take  on  fat  which 
varies  in  character  is  well  known  to  breeders 
of  cattle.  ^'  The  art  of  breeding  and  feeding 
stock,"  says  Dr.  Letheby,^  "  is  to  overcome  ex- 
cessive tendency  to  accumulation  of  either  sur- 
face fat  or  visceral  fat,  and  at  the  same  time  to 
produce  a  fat  which  will  not  melt  or  boil  away  in 
cooking.  Oily*  foods  have  a  tendency  to  make 
soft  fats  w^hich  will  not  bear  cooking."  Such 
differences  are  also  seen  between  English  and 
American  bacon,  the  former  being  much  more 

»Letheby  on  Food,  pp.  39,  40,  41. 


GAIN  OR   LOSS   OF    WEIGHT.  27 

solid ;  and  we  know,  also,  that  the  fat  of  different 
animals  varies  remarkably,  and  that  some,  as 
the  fat  of  hay-fed  horses,  is  readily  worked  oft*. 
Such  facts  as  these  may  reasonably  be  held  to  sus- 
tain the  popular  creed  as  to  there  being  bad  fats 
and  good  fats,  and  they  teach  us  the  lesson  that 
in  man,  as  in  animals,  there  may  be  a  difference 
in  the  value  of  the  fats  we  acquire,  according  as 
they  are  gained  by  one  means  or  by  another. 

The  recent  researches  of  L.  Langer  have  cer- 
tainly shown  that  the  fatty  tissues  of  man  vary 
at  different  ages,  in  the  proportion  of  the  fatty 
acids  they  contain. 

I  have  had  occasion,  of  late  years,  to  watch 
with  interest  the  process  of  somewhat  rapid  but 
quite  wholesome  gain  in  flesh  in  persons  sub- 
jected to  the  treatment  which  I  shall  by  and 
by  describe.  Most  of  these  persons  were  treated 
by  massage,  and  I  have  been  accustomed  to 
question  the  masseur  or  masseuse  as  to  the  man- 
ner in  which  the  change  takes  place.  Usually 
it  is  first  seen  in  the  face  and  neck,  then  it  is 
noticed  in  the  back  and  flanks,  next  in  the  belly, 
and  finally  in  the  limbs,  the  legs  coming  last  in 
the  order  of  gain,  and  sometimes  remaining 
comparatively  thin  long  after  other  parts  have 


28  GAIN  OR  LOSS  OF   WEIGHT. 

made  remarkable  and  visible  gain.  These  ob- 
servations have  been  checked  by  careful  meas- 
urements, so  that  I  am  sure  of  their  correctness 
for  people  who  fatten  while  at  rest  in  bed.  The 
order  of  increase  might  be  different  in  people 
who  fatten  while  afoot. 

Facts  of  this  nature  suggest  that  the  putting 
on  of  fat  must  be  due  to  very  generalized  condi- 
tions, and  be  less  under  the  control  of  local  causes 
than  is  the  nutrition  of  muscles,  for,  while  it  is 
true  that  in  wasting  from  nerve-lesions  the  mus- 
cular and  fatty  tissues  alike  lessen,  it  is  possible 
to  cause  by  exercise  rapid  increase  in  the  bulk 
of  muscle  in  a  limb  or  a  part  of  a  limb,  but  not 
in  any  way  to  cause  direct  and  limited  local 
increment  of  fat. 

Looking  back  over  the  whole  subject,  it  will 
be  well  for  the  physician  to  remember  that  in- 
crease of  fat,  to  be  a  wholesome  condition,  should 
be  accompanied  by  gain  in  quantity  and  quality 
of  blood,  and  that  while  increase  of  ftesh  after 
illness  is  desirable,  and  a  good  test  of  successful 
recovery,  it  should  always  go  along  with  improve- 
ment in  color.  Obesity  with  thin  blood  is  one  of 
the  most  unmanageable  conditions  I  know  of. 

The  exact  relations  of  fatty  tissue  to  the  states 


GAIN  OR  LOSS  OF   WEIGHT.  29 

of  health  are  not  as  yet  well  understood ;  but, 
since  on  great  exertion  or  prolonged  mental  or 
moral  strain  or  in  low  fevers  we  lose  fat  rap- 
idly, it  may  be  taken  for  granted  that  each  indi- 
vidual should  possess  a  certain  surplus  of  this 
readily-lost  material.  It  is  the  one  portion  of 
our  body  which  oomes  and  goes  in  large  amount. 
Even  thin  people  have  it  in  some  quantity  always 
ready,  and,  despite  the  fluctuations,  every  one 
has  a  standard  share,  which  varies  at  different 
times  of  life.  The  mechanism  which  limits  the 
storing  away  of  an  excess  is  almost  unknown, 
and  we  are  only  aware  that  some  foods  and  lack 
of  exertion  favor  growth  in  fat,  while  action  and 
lessened  diet  diminish  it;  but  also  we  know  that 
while  any  one  can  be  made  to  lose  weight,  there 
are  some  persons  who  cannot  be  made  to  gain  a 
pound  by  any  possible  device,  so  that  in  this,  as 
in  other  things,  to  spend  is  easier  than  to  get; 
although  it  is  clear  that  the  very  thin  must  cer- 
tainly live,  so  to  speak,  from  hand  to  mouth, 
and  have  little  for  emergencies.  Whether  fat 
people  possess  greater  power  of  resistance  as 
against  the  fatal  wasting  of  certain  maladies  or 
not,  does  not  seem  to  be  known,  and  I  fancy  that 

the  popular  medical  belief  is  rather  opposed  to 

3* 


30  OAIN  OR  LOSS   OF   WEIGHT. 

a  belief  in  the  vital  endurance  of  those  who  are 
unusually  fat. 

That  I  am  not  pushing  too  far  this  idea  of  the 
indicative  value  of  gain  of  weight  may  be  further 
seen  in  persons  who  suffer  from  some  incurable 
chronic  malady,  but  who  are  in  other  respects 
well.  The  relief  from  their  disease,  even  if  tem- 
porary, is  apt  to  be  signalled  by  abrupt  gain  in 
weiofht.  A  remarkable  illustration  is  to  be  found 
iu  those  who  suffer  periodically  from  severe  pain. 
Cessation  of  these  attacks  for  a  time  is  sure  to 
result  in  the  putting  on  of  flesh.  The  case  of 
Captain  Catlin^  is  a  good  example.  Owing  to  an 
accident  of  war,  he  lost  a  leg,  and  ever  since  has 
had  severe  neuralgic  pain  referred  to  the  lost 
leg.  These  attacks  depend  almost  altogether  on 
storms.  In  years  of  fewest  storms  they  are  least 
numerous,  and  the  bodily  weight,  which  is  never 
insufficient,  rises.  "With  their  increase  it  lowers 
to  a  certain  amount,  beneath  which  it  does  not 
fall.  His  weight  is,  therefore,  indirectly  de- 
pendent upon  the  number  of  storms  to  the  in- 
fluence of  which  he  is  exposed. 

1  Am.  Jour.  Med.  Sci.  ;  Proc.  Phil.  Coll.  of  Phys.,  1883; 
Phil.  Med.  News,  April,  1883. 


GAIN  OR  LOSS  OF    WEIGHT.  31 

At  present,  however,  we  have  to  do  most 
largely  with  the  means  of  attaining  that  mod- 
erate share  of  stored-away  fat  which  seems  to 
indicate  a  state  of  nutritive  prosperity  and  to  be 
essential  to  those  physical  needs,  such  as  protec- 
tion and  padding,  which  fat  subserves,  no  less 
than  to  its  aesthetic  value,  as  rounding  the  curves 
of  the  human  form. 

The  study  of  the  amount  of  the  different  forms 
of  diet  which  is  needed  by  jDeople  at  rest,  and 
by  those  who  are  active,  is  valuable  only  to  en- 
able us  to  construct  dietaries  with  care  for  masses 
of  men  and  where  economy  is  an  object.  In 
dealing  with  cases  such  as  I  shall  describe,  it  is 
needful  usually  to  give  and  to  have  digested  a 
surplus  of  food,  so  that  we  are  more  concerned 
now  to  know  the  forms  of  food  which  thin  or 
fatten,  and  the  means  which  aid  us  to  digest 
temporarily  an  excess. 

As  to  quantity,  it  suffices  to  say  that  while  by 
lessening  food  we  may  easily  and  surely  make 
people  lose  weight,  we  cannot  be  sure  to  fatten 
by  merely  increasing  the  amount  of  food  given ; 
something  more  is  wanted  in  the  way  of  digest- 
ives or  tonics  to  enable  the  patient  to  prepare 
and  appropriate  what  is  given,  and  but  too  often 


32  GAIN  OR  LOSS  OF   WEIGHT. 

we  fail  miserably  in  all  our  means  of  giving 
capacity  to  assimilate  food.  As  I  have  said  be- 
fore, and  wish  to  repeat,  to  gain  in  fat  is  nearly 
always  to  gain  in  blood  ;  and  I  hope  to  point  out 
in  these  pages  some  of  the  means  by  which  these 
ends  can  be  attained  when  all  usual  methods 
have  failed. 


CHAPTER    III. 

ON   THE   SELECTION    OF   CASES   FOR   TKEATMENT. 

The  remarks  of  the  last  chapter  have,  of  course, 
wide  and  general  application  in  disease,  and  nat- 
urally lead  up  to  what  I  have  to  say  as  to  the 
employment  of  the  systematic  treatment  to  de- 
scribe which  is  my  chief  desire.  Its  use,  as  a 
whole,  is  limited  to  certain  groups  of  cases.  In 
some  of  the  worst  of  them  nothing  else  has  suc- 
ceeded hitherto,  or  at  least  as  frequently.  In 
others  the  need  for  its  application  must  depend 
on  convenience  and  the  fact  that  all  other  and 
readier  means  have  failed.  It  is,  of  course,  diffi- 
cult to  state  now  all  the  groups  of  diseases  in 
which  it  may  be  of  value,  for  already  physicians 
have  begun  to  find' it  serviceable  in  some  to 
which  I  had  not  thought  of  applying  it,^  and  its 
sphere  of  usefulness  is  therefore  likely  to  extend 


^  Chorea.     See  Lancet,  Aug.  1882. 

33 


34     SELECTION  OF  CASES  FOR   TREATMENT. 

beyond  the  limits  originally  set  by  me.  It  will 
be  well  here,  however,  to  state  the  various  dis- 
orders in  which  it  has  seemed  to  me  applicable. 
As  regards  some  of  them,  I  shall  try  briefly  to 
indicate  why  their  peculiarities  point  it  out  as 
needful. 

There  are,  of  course,  numerous  cases  in  which 
it  becomes  desirable  to  fatten  and  to  make  blood. 
In  many  of  them  these  are  easy  tasks,  and  in 
some  altogether  hopeless.  Persons  who  are  re- 
covering healthfully  from  fevers,  pneumonias, 
and  other  temporary  maladies  gather  flesh  and 
make  blood  readily,  and  we  need  only  to  help 
them  by  the  ordinary  tonics,  careful  feeding,  and 
change  of  air  in  due  season. 

It  may  not,  however,  be  out  of  place  to  say 
here  that  when  the  convalescence  from  these 
maladies  seems  to  be  slower  than  is  common, 
and  ordinary  tonics  inefl&cient,  massage  and  the 
use  of  electricity  are  not  unimportant  aids  to- 
wards health,  but  in  such  cases  require  to  be 
handled  with  an  amount  of  caution  which  is  less 
requisite  in  miore  chronic  conditions  of  dis- 
ordered health. 

In  other  and  fatal  or  graver  maladies,  such  as, 
for  example,  advanced  pulmonary  phthisis,  how- 


SELECTION  OF   CASES  FOR    TREATMENT.    35 

ever  proper  it  may  be  to  fatten,  it  is  almost 
an  impossible  task,  and,  as  Pollock  remarks,  the 
lung-trouble  may  be  advancing  even  while  the 
patient  is  gaining  in  weight. 

There  remains  a  class  of  cases  desirable  to 
fatten  and  redden, — cases  which  are  often,  or 
usually,  chronic  in  character,  and  present  among 
them  some  of  the  most  difficult  problems  which 
perplex  the  phj'sician.  If  I  pause  to  dwell  upon 
these,  it  is  because  they  exemplify  forms  of  dis- 
ease in  which  my  method  of  treatment  has  had 
the  largest  success ;  it  is  because  some  of  them 
are  simply  living  records  of  the  failure  of  every 
other  rational  plan  and  of  many  irrational  ones ;, 
it  is  because  many  of  them  find  no  place  in  the 
text-book,  however  sadly  familiar  they  are  to  t]  j 
physician. 

The  group  I  would  speak  of  contains  that  large 
number  of  people  who  are  kept  meagre  and  often 
also  ansemic  by  constant  dyspepsia,  in  its  varied 
forms,  or  by  those  defects  in  assimilative  processes 
which,  while  more  obscure,  are  as  fertile  parents 
of  similar  mischiefs.  Let  us  add  the  long-con- 
tinued malarial  poisonings,  and  we  have  a  group 
of  varied  origin  which  is  a  moderate  percentage 
of  cases  in  which  loss  of  weight  and  loss  of  color 


56   SELECTION  OF  CASES  FOR    TREATMENT. 

are  noticeable,  and  in  which  the  usual  therapeutic 
methods  do  sometimes  utterly  fail. 

For  many  of  these,  fresh  air,  exercise,  change 
of  scene,  tonics,  and  stimulants  are  alike  value- 
less; and  for  them  the  combined  employment 
of  the  tonic  influences  I  shall  describe,  when 
used  with  absolute  rest,  massage,  and  electricity, 
is  often  of  inestimable  service. 

A  portion  of  the  class  last  referred  to,  and 
'which   I   have  yet   to   describe,  is   one  I  have 

/hinted  at  as  the  despair  of  the  physician.  It 
includes  that  large  group  of  women,  especially, 
said  to  have  nervous  exhaustion,  or  who  are  de- 
fined as  having  spinal  irritation,  if  that  be  the 
prominent  symptom.  To  it  I  must  add  cases  in 
which,  besides  the  wasting  and  anaemia,  emo- 
tional manifestations  predominate,  and  which  are 

'  then  called  hysterical,  whether  or  not  they  ex- 

^)iibit  ovarian  or  uterine  disorders. 

Nothing  is  more  common  in  practice  than  to 

;  see  a  young  woman  who  falls  below  the  health- 
standard,  loses  color  and  plumpness,  is  tired  all 
the  time,  by  and  by  has  a  tender  spine,  and  soon 
or  late  enacts  the  whole  varied  drama  of  hysteria. 
As  one  or  other  set  of  symptoms  is  prominent 

'  she  gets  the  appropriate  label,  and  sometimes  she 


SELECTION  OF  CASES  FOR   TREATMENT.    37 

continues  to  exhibit  only  the  single  phase  of 
nervous  exhaustion  or  of  spinal  irritation.  Far 
more  often  she  runs  the  gauntlet  of  nerve-doc- 
tors, gynaecologists,  plaster  jackets,  braces,  water- 
treatment,  and  all  the  fantastic  variety  of  other 
cures. 

It  will  be  worth  while  to  linger  here  a  little 
and  more  sharply  delineate  the  classes  of  cases  I 
have  just  named. 

I  see  every  week — almost  every  day — women 
who  when  asked  what  is  the  matter  reply,  "  Oh, 
I  have  nervous  exhaustion."  When  further 
questioned,  they  answer  that  everything  tires 
them.  l!^ow,  it  is  vain  to  speak  of  all  of  these 
cases  as  hysterical,  or  as  merely  mimetic.  It  is 
quite  sure  that  in  the  graver  examples  exercise 
quickens  the  pulse  curiously,  the  tire  shows  in 
the  face,  or  sometimes  diarrhoea  or  nausea  fol- 
lows exertion,  and  though  while  under  excite- 
ment or  in  the  presence  of  some  dominant  mo- 
tive they  can  do  a  good  deal,  the  exhaustion 
which  ensues  is  out  of  proportion  to  the  exercise 
used. 

I  have  rarely  seen  such  a  case  which  was  not 

more  or  less  lacking  in  color  and  which  had  not 

lost  flesh;  the  exceptions  being   those  trouble- 

4 


38   SELECTION  OF  CASES  FOR    TREATMENT. 

some  instances  of  fat  anaemic  people  which  I 
shall  by  and  by  speak  of  more  fully. 

Perhaps  a  sketch  of  one  of  these  cases  will  be 
better  than  any  list  of  symptoms.  A  woman, 
most  often  between  twenty  and  thirty  years  of 
age,  undergoes  a  season  of  trial  or  encounters 
some  prolonged  strain.  She  may  have  under- 
taken the  hard  task  of  nursing  a  relative,  and 
have  gone  through  this  severe  duty  with  the  ad- 
dition of  emotional  excitement,  swayed  by  hopes 
and  fears,  and  forgetful  of  self  and  of  what 
every  one  needs  in  the  way  of  air  and  food  and 
change  when  attempting  this  most  trying  task. 
In  another  set  of  cases  an  illness  is  the  cause, 
and  she  never  rallies  entirely,  or  else  some  local 
uterine  trouble  starts  the  mischief,  and,  although 
this  is  cured,  the  doctor  wonders  that  his  patient 
does  not  get  fat  and  ruddy  again. 

But,  no  matter  how  it  comes  about,  whether 
from  illness,  anxiety,  or  prolonged  physical  ef- 
fort, the  woman  grows  pale  and  thin,  eats  little, 
or  if  she  eats  does  not  profit  by  it.  Everything 
wearies  her, — to  sew,  to  write,  to  read,  to  walk, 
— and  b}^  and  by  the  sofa  or  the  bed  is  her  only 
comfort.  Every  effort  is  paid  for  dearly,  and 
she  describes  herself  as  aching  and  sore,  as  sleep- 


SELECTION   OF  CASES  FOR    TREATMENT.    39 

ing  ill  and  awaking  un refreshed ,  and  as  need- 
ing: constant  stimulus  and  endless  tonics.  Then 
comes  the  mischievous  role  of  bromides,  opium, 
chloral,  and  brandy.  If  the  case  did  not  begin 
with  uterine  troubles,  they  soon  appear,  and  are 
usually  treated  in  vain  if  the  general  means  em- 
ployed to  build  up  the  bodily  health  fail,  as  in 
many  of  these  cases  they  do  fail.  The  same  re- 
mark applies  to  the  dyspepsias  and  constipation 
which  further  annoy  the  patient  and  embarrass 
the  treatment.  If  such  a  person  is  by  nature 
emotional  she  is  sure  to  become  more  so,  for  even 
the  firmest  women  lose  self-control  at  last  under 
incessant  feebleness.  JSTor  is  this  less  true  of 
men  ;  and  I  have  many  a  time  seen  soldiers  who 
had  ridden  boldly  with  Sheridan  or  fought  gal- 
lantly with  Grant  become,  under  the  influence 
of  painful  nerve-wounds,  as  irritable  and  hys- 
terically emotional  as  the  veriest  ^irl.  If  no 
rescue  comes,  the  fate  of  women  thus  disordered 
is  at  last  the  bed.  They  acquire  tender  spines, 
and  furnish  the  most  lamentable  examples  of  all 
the  strange  phenomena  of  hysteria. 

The  moral  degradation  which  such  cases  un-  ' 
dergo  is  pitiable.     I  have  heard  a  good  deal  of 
the  disciplinary  usefulness  of  sickness,  and  this  , 


40  SELECTION  OF  CASES  FOR   TREATMENT. 

may  well  apply  to  brief  and  grave,  and  what  I 
might  call  wholesome,  maladies.  Undoubtedly 
I  have  seen  a  few  people  who  were  ennobled  by 
long  sickness,  but  far  more  often  the  result  is 
to  cultivate  self-love  and  selfishness  and  to  take 
away  by  slow  degrees  the  healthful  mastery 
which  all  human  beings  should  retain  over  their 
own  emotions  and  wants. 

There  is   one   fatal    addition   to   the   weight 

which  tends  to  destroy  women  who  suffer  in  the 

way  I  have  described.     It  is  the  self-sacrificing 

love  and  over-careful  sympathy  of  a  mother,  a 

sister,  or  some  other  devoted  relative.     Nothing 

is  more  curious,  nothing  more  sad  and  pitiful, 

than   these  partnerships  between  the  sick   and 

selfish  and  the  sound  and  over-loving.     By  slow 

but  sure  degrees  the  healthy  life  is  absorbed  by 

the  sick  life,  in  a  manner  more  or  less  injurious 

to  both,  until,  sometimes  too  late  for  remedy,  the 

j  growth  of  the  evil  is  seen  by  others.     Usually 

(the  individual  withdrawn  from  wholesome  duties 

to  minister  to  the  caprices  of  hysterical  sensi- 

/tiveness  is  the  person  of  a  household  who  feels 

most   for   the   invalid,  and   who   for   this   very 

Ireason  suffers  the  most.     The  patient  has  pain, 

— a  tender  spine,  for  example ;  she  is  urged  to 


SELECTION  OF  CASES  FOR   TREATMENT.    4X 

give  it  rest.  She  cannot  read;  the  self-consti- 
tuted nurse  reads  to  her.  At  last  light  hurts 
her  eyes ;  the  mother  or  sister  remains  shut  up 
with  her  all  day  in  a  darkened  room.  A  draught 
of  air  is  supposed  to  do  harm,  and  the  doors  and 
windows  are  closed,  and  the  ingenuity  of  kind- 
ness is  taxed  to  imagine  new  sources  of  like 
trouble,  until  at  last,  as  I  have  seen  more  than 
once,  the  window-cracks  are  stuffed  with  cotton, 
the  chimney  is  stopped,  and  even  the  keyhole 
guarded.  It  is  easy  to  see  where  this  all  leads 
to:  the  nurse  falls  ill,  and  a  new  victim  is  found. 
I  have  seen  an  hysterical,  anaemic  girl  kill  in 
this  way  three  generations  of  nurses.  If  you 
tell  the  patient  she  is  basely  selfish,  she  is  prob- 
ably amazed,  and  wonders  at  your  cruelty.  To 
cure  such  a  case  you  must  morally  alter  as  well 
as  physically  amend,  and  nothing  less  will  an- 
swer. The  first  step  needful  is  to  break  up  the 
companionship,  and  to  substitute  the  firm  kind- 
ness of  a  well-trained  hired  nurse.^ 

Another  form  of  evil   to   be  encountered  in 
these  cases  is  less  easy  to  deal  with.     Such  an 


^"  Nurse  and   Patient."    S.  Weir  Mitchell.     Lippincott'a 
Magazine,  Dec.  1872. 

4* 


42  SELECTION  OF  CASES  FOR   TREATMENT. 

invalid  has  by  unhappy  chance  to  live  with  some 
near  relative  whose  temperament  is  also  nervous 
and  who  is  impatient  or  irritable.  Two  such 
people  produce  endless  mischief  for  each  other. 
Occasionally  there  is  a  strange  incompatibility 
which  it  is  difficult  to  define.  The  two  people 
who,  owing  to  their  relationship,  depend  the 
one  on  the  other,  are,  for  no  good  reason,  made 
unhappy  by  their  several  peculiarities.  Life- 
long annoyance  results,  and  for  them  there  is 
no  divorce  possible. 

in  a  smaller  number  of  cases,  which  have  less 
tendency  to   emotional    disturbances,  the    phe- 
nomena are  more  simple.      You   have  to  deal 
with  a  woman  who   has  lost  flesh  and  grown 
colorless,  but  has  no  hysterical  tendencies.     She 
i  is  merely  a  person  hopelessly  below  the  standard 
of  health  and   subject  to  a  host  of  aches  and 
pains,  without  notable   organic  disease.     "Why 
such  people  should  sometimes  be  so  hard  to  cure 
I  cannot  say.     But  the  sad  fact  remains.     Iron, 
acids,  travel,  water-cures,  have  for  a  certain  pro- 
portion of  them  no  value,  or  little  value,  and 
i  they  remain  for  years  feeble  and  forever  tired. 
For  them,  as  for  the  whole  class,  the  pleasures 
of  life  are  limited  by  this  perpetual  weariness 


SELECTION  OF  CASES  FOR    TREATMENT.    43 

and  by  the  asthenopia  which  they  rarely  escape, 
and  which,  by  preventing  them  from  reading, 
leaves  them  free  to  study  day  after  day  their 
accumulating  aches  and  distresses.  ^ 

Medical  opinion  must,  of  course,  vary  as  to 
the  causes  which  give  rise  to  the  familiar  dis- 
orders I  have  so  briefly  sketched,  but  I  imagine 
that  few  physicians  placed  face  to  face  with  such 
cases  would  not  feel  sure  that  if  they  could  in- 
sure to  these  patients  a  liberal  gain  in  fat  and 
in  blood  they  would  be  certain  to  need  very  little 
else,  and  that  the  troubles  of  stomach,  bowels, 
and  uterus  would  speedily  vanish. 

I  need  hardly  say  that  I  do  not  mean  by  this 
that  the  mere  addition  of  blood  and  normal  flesh 
is  what  we  want,  but  that  their  gradual  increase 
will  be  a  visible  result  of  the  multitudinous 
changes  in  digestive,  assimilative,  and  secretive 
power  in  which  the  whole  economy  inevitably 
shares,  and  of  which  my  relation  of  cases  will  be 
a  better  statement  than  any  more  general  one  I 
could  make  here. 

Such  has  certainly  been  the  result  of  my  own 
very  ample  experience.  If  I  succeed  in  first 
altering  the  moral  atmosphere  which  has  been  to 
the  patient  like  the  very  breathing  of  evil,  and  if  ' 


44  SELECTION  OF  CASES  FOR    TREATMENT, 

I  can  add  largely  to  the  weiglit  and  fill  the  ves- 
sels with  red  blood,  I  am  usually  sure  of  giving 
\ general  relief  to  a  host  of  aches,  pains,  and 
jvaried  disabilities.  If  I  fail,  it  is  because  I  fail 
in  these  very  points,  or  else  because  I  have  over- 
looked or  undervalued  some  serious  organic  tis- 
sue-change. 

f.  It  will  have  been  seen  that  I  am  careful  in  the 
selection  of  cases  for  this  treatment.  Conducted 
under  the  best  circumstances  for  success,  it  in- 
volves a  good  deal  that  is  costly.  ISTeither  does 
it  answer  as  well,  and  for  obvious  treasons,  in 
hospital  wards ;  and  this  is  most  true  in  regard 
to  persons  who  are  demonstratively  hysterical. 
As  a  rule,  the  worse  the  case,  the  more  emaciated, 
the  more  easy  is  it  to  manage,  to  control,  and  to 
cure.  It  is,  as  Play  fair  remarks^the  half-ill  who 
constitute  the  difiicult  cases. 

I  am  also  very  careful  as  to  being  sure  of 
the  absence  of  certain  forms  of  organic  disease 
before  flattering  myself  with  the  probability  of 
success.  But  not  all  organic  troubles  forbid  the 
use  of  this  treatment.  Advanced  Bright's  dis- 
ease does;  but  intestinal  troubles  which  are  not 
tubercular  or  malignant  do  not ;  nor  do  moder- 
ate signs  of  chronic  pulmonary  deposits,  or  bron- 


SELECTION  OF  CASES  FOR   TREATMENT.    45 

chitis,  nor,  as  a  rule,  heart  disease  in  its  milder 
forms.^ 

On  the  other  hand,  the  true  melancholias,  which .' 
are  not  merely  depression  of  spirits  from  loss  of 
all  hope  of  relief,  are  best  let  alone,  as  far  as 
this  treatment  is  concerned.  The  nutritive  fail- 
ures which  so  often  accompany  them  must  be 
met  by  other  means  than  rest,  seclusion,  etc.  ;f 
and  in  this  opinion  I  am  sustained  by  some  fail- 
ures on  my  own  part,  and  by  the  opinions  of 
Goodell  and  PI  ay  fair. 

In  the  following  chapters  I  shall  treat  of  the 
means  which  I  have  employed,  and  shall  not 
hesitate  to  give  such  minute  details  as  shall  en- 
able others  to  profit  by  my  failures  and  successes. 
In  describing  the  remedies  used,  and  the  mode 
of  using  them  in  combination,  I  shall  relate  a 
sufficient  number  of  cases  to  illustrate  both  the 
happier  results  and  the  causes  of  occasional  fail- 
ure. 

The  treatment  I  am  about  to  describe  consists 
in  seclusion,  certain  forms  of  diet,  rest  in  bed, 
massage  (or  manipulation),  and  electricity ;  and 

*  See  Philip  Karell's  remarks  on  the  use  of  treatment  by 
milk  in  cardiac  hypertrophy.     Edin.  Med   Jour.,  Aug.  1866. 


46   SELECTION  OF  CASES  FOR    TREATMENT. 

I  desire  to  insist  anew  on  the  fact  that  in  most 
/  cases  it  is  the  combined  use  of  these  means  that 

is  wanted.  How  far  they  may  be  modified  or 
j  used  separately  in  some  instances,  I  shall  have 
I  occasion  to  point  out  as  I  discuss  the  various 
\  agencies  alluded  to. 


CHAPTER   lY. 


SECLUSION. 


It  is  rare  to  find  any  of  the  class  of  patients  I 
have  described  so  free  from  the  influence  of  their 
habitual  surroundings  as  to  make  it  easy  to  treat 
them  in  their  own  homes.  It  is  needful  to  dis- 
entangle them  from  the  meshes  of  old  habits  and 
to  remove  them  from  contact  with  those  who 
have  been  the  willing  slaves  of  their  caprices. 
I  have  often  made  the  effort  to  treat  them 
where  they  have  lived  and  to  isolate  them  there, 
but  I  have  rarely  done  so  without  promising 
myself  that  I  would  not  again  complicate  my 
treatment  by  any  such  embarrassments.  Once 
separate  the  patient  from  the  moral  and  physical 
surroundings  which  have  become  part  of  her  life 
of  sickness,  and  you  will  have  made  a  change 
which  will  be  in  itself  beneficial  and  will  enor- 
mously aid  in  the  treatment  which  is  to  follow. 
Of  course  this  step  is  not  essential  in  such  cases 

as  are  merely  ansemic,  feeble,  and  thin,  owing  to 

47 


48  SECLUSION. 

distinct  causes,  like  tlie  exhaustion  of  overwork, 
blood-losses,  dyspepsia,  low  fevers,  or  nursing. 
There  are  but  too  many  women  who  have  broken 
down  under  such  causes  and  failed  to  climb  again 
to  the  level  of  health,  despite  all  that  could  be 
done  for  them ;  and  when  such  persons  are  free 
from  emotional  excitement  or  hysterical  compli- 
cations there  is  no  reason  why  the  seclusion  need- 
ful to  secure  them  repose  of  mind  should  not  be 
pleasantly  modified  in  accordance  with  the  dic- 
tates of  common  sense.  Very  often  a  little  ex- 
perimentation as  to  what  they  will  profitably  bear 
in  the  way  of  visits  and  the  like  will  inform  us, 
as  their  treatment  progresses,  how  far  such  in- 
dulgence is  of  use  or  free  from  hurtful  influences. 
Cases  of  extreme  neurasthenia  in  men  accom- 
panied with  nutritive  failures  require  as  to  this 
matter  cautious  handling,  because,  for  some 
reason,  the  ennui  of  rest  and  seclusion  is  far 
better  borne  by  women  than  by  the  other  sex. 

Even  in  cases  whose  moral  aspects  do  not  at 
once  suggest  an  imperative  need  for  seclusion  it 
is  well  to  remember,  as  regards  neurasthenic  peo- 
ple, that  the  treatment  involxes  for  a  time  daily 
visits  of  some  length  from  the  masseur,  the  doc- 
tor, and  possibly  an  electrician,  and  that  to  add 


SECLUSION.  49 

to  these  even  a  single  friendly  visitor  is  often  too 
much  to  be  readily  borne ;  but  I  am  now  speak- 
ing chiefly  of  the  large  and  troublesome  class  of 
thin-blooded  emotional  women,  for  whom  a  state 
of  weak  health  has  become  a  long  and,  almost  I 
might  say,  a  cherished  habit.  For  them  there  is 
often  no  success  possible  until  we  have  broken 
up  the  whole  daily  drama  of  the  sick-room,  with 
its  little  selfishness  and  its  craving  for  sympathy 
and  indulgence.  ISTor  should  we  hesitate  to  in- 
sist upon  this  change,  for  not  only  shall  we  then 
act  in  the  true  interests  of  the  patient,  but  we 
shall  also  confer  on  those  near  to  her  an  inesti- 
mable benefit.  An  hysterical  girl  is,  as  Wendell 
Holmes  has  said  in  his  decisive  phrase,  a  vam- 
pire who  sucks  the  blood  of  the  healthy  people 
about  her;  and  I  may  add  that  ]3retty  surely 
where  there  is  one  hysterical  girl  there  will  be 
soon  or  late  two  sick  women.  If  circumstances 
oblige  us  to  treat  such  a  person  in  her  own  home, 
let  us  at  least  change  her  room,  and  also  have  it 
well  understood  how  far  we  are  to  control  her 
surroundings  and  to  govern  as  to  visitors  and  the 
company  of  her  own  family.  Do  as  we  may,  we 
shall  always  lessen  thus  our  chances  of  success, 
but  we  shall  certainly  not  altogether  destroy  them. 


50  SECLUSION. 

I  should  add  here  a  few  words  of  caution  as 
to  the  time  of  year  best  fitted  for  treatment.  In 
the  summer  seclusion  is  often  undesirable  when 
the  patient  is  well  enough  to  gain  help  by  change 
of  air ;  moreover,  at  this  season  massage  is  less 
agreeable  than  in  winter,  and,  as  a  rule,  I  find  it 
harder  to  feed  and  to  fatten  persons  at  rest  dur- 
ing our  summer  heats.  That  this  rule  is  not 
without  exception  has  been  shown  by  Drs. 
Goodell  and  Sinkler,  both  of  whom  have  attained 
some  remarkable  successes  in  midsummer. 

One  of  the  questions  of  most  importance  in  the 
carrying  out  of  this  treatment  is  the  choice  of  a 
nurse.  Just  as  it  is  desirable  to  change  the 
home  of  the  patient,  her  diet,  her  atmosphere,  so 
also  is  it  well,  for  the  mere  alterative  value  of 
such  change,  to  surround  her  with  strangers  and 
to  put  aside  any  nurse  with  whom  she  may  have 
grown  familiar.  As  I  have  sometimes  succeeded 
in  treating  invalids  in  their  own  homes,  so  have 
I  occasionally  been  able  to  carry  through  cases 
nursed  by  a  mother,  or  sister,  or  friend  of  ex- 
ceptional firmness ;  but  to  attempt  this  is  to  be 
heavily  handicapped,  and  the  position  should 
never  be  accepted  if  it  be  possible  to  make  other 
arrangements.     Any  firm,  intelligent  woman  of 


SECLUSION.  51 

tact,  a  stranger  to  the  patient,  is  better  than  the 
old  style  of  nurse,  now,  happily,  disappearing. 
The  nurse  for  these  cases  ought  to  be  a  young, 
active,  quick-witted  woman,  capable  of  firmly 
but  gently  controlling  her  patient.  She  ought  to 
be  intelligent,  able  to  interest  her  patient,  to  read 
aloud,  and  to  write  letters.  The  more  of  these 
cases  she  has  seen  and  nursed,  the  easier  becomes 
the  task  of  the  doctor.  It  is  always  to  be  borne 
in  mind  that  most  of  these  patients  are  over- 
sensitive, refined,  and  educated  women,  for 
whom  the  clumsiness,  or  want  of  neatness,  or 
bad  manners,  or  immodesty  of  a  nurse  may  be  a 
sore  and  steadily-increasing  trial.  To  be  more 
or  less  isolated  for  two  months,  in  a  room  with, 
one  constant  attendant,  however  good,  is  hardl 
enough  for  any  one  to  endure  ;  and  certain  quite  • 
small  faults  or  defects  in  a  nurse  may  make  her  a 
serious  impediment  to  the  treatment,  because  no 
mere  technical  training  will  dispense  in  the  nurse 
any  more  than  in  the  physician  with,  those  finer 
natural  qualifications  which  make  their  training 
available.  But  one  nurse  will  suit  one  patient 
and  not  another :  so  that  I  never  hesitate  to 
change  my  nurse  if  she  does  not  fit  the  case. 


CHAPTER   Y. 

REST. 

I  HAVE  said  more  than  once  in  the  early  chap- 
ters of  this  little  volume  that  the  treatment  I 
wished  to  advise  as  of  use  in  a  certain  range  of 
cases  was  made  up  of  rest,  massage,  electricity, 
and  over-feeding.  I  said  that  the  use  of  large 
amounts  of  food  while  at  rest,  more  or  less  en- 
tire, was  made  possible  by  the  practice  of  knead- 
ing the  muscles  and  by  moving  them  with  cur- 
rents able  to  effect  this  end.  I  desire  now  to 
discuss  in  turn  the  mode' in  which  I  employ  rest, 
massage,  and  electricity,  and,  as  I  have  promised, 
I  shall  take  pains  to  give,  in  regard  to  these  three 
subjects,  the  fullest  details,  because  success  in  the 
treatment  depends,  I  am  sure,  on  the  care  with 
which  we  look  after  a  number  of  things  each  in 
itself  apparently  of  slight  moment. 

I  have  no'  doubt  that  many  doctors  have  seen 

fit  at  times  to  put  their  patients  at  rest  for  great 

or  small  lengths  of  time,  but  the  person  who  of 
52 


REST.  53 

all  others  within  my  knowledge  used  this  means 
most,  and  used  it  so  as  to  obtain  the  best  results, 
was  the  late  Professor  Samuel  Jackson.  He  was 
in  the  habit  of  making  his  patients  remain  in  bed 
for  many  weeks  at  a  time,  and,  if  I  recall  his 
cases  well,  he  used  this  treatment  in  just  the  class 
of  disorders  among  women  which  have  given  me 
the  best  results.  What  these  are  I  have  been  at 
some  pains  to  define,  and  I  have  now  only  to 
show  why  in  such  people  rest  is  of  service,  and 
what  I  mean  by  rest,  and  how  I  apply  it. 

In  'Eo.  lY.  of  Dr.  Seguin's  series  of  American 
Clinical  Lectures,  I  was  at  some  pains  to  point 
out  the  value  of  repose  in  neuralgias,  and  especi- 
ally sciatica,  in  myelitis,  and  in  the  early  stages 
of  locomotor  ataxia,  and  I  have  since  then  had 
the  pleasure  of  seeing  these  views  very  fully  ac- 
cepted. I  shall  now  confine  myself  chiefly  to  its 
use  in  the  various  forms  of  weakness  which  exist 
with  thin  blood  and  wasting,  with  or  without 
distinct  lesions  of  the  stomach,  womb,  or  other 
organs. 

Whether  we  shall  ask  a  patient  to  walk  or  to 
take  rest  is  a  question  which  turns  up  for  an- 
swer almost  every  day  in  practice.     Most  often 

we  incline  to  insist  on  exercise,  and  are  led  to  do 

5* 


54  REST. 

SO  from  a  belief  that  many  people  walk  too  little, 
and  that  to  move  about  a  good  deal  every  day  is 
w^ell  for   everybody.      I  think  we  are  as  often 
wrong  as  right.     A  good  brisk  daily  walk  is  for 
well  folks  a  tonic,  breaks  down  old  tissues,  and 
creates   a  wholesome   demand   for  food.      The 
same  is  true  for  some  sick  people.     The  habit  of 
horse-exercise  or  a  long  walk  every  day  is  needed 
to  cure  or  to  aid  in  the  cure  of  disordered  stomach 
and  costive  bowels,  but  if  all  exertion  gives  rise 
only  to  increase  of  trouble,  to  extreme  sense  of 
fatigue,  to  nausea,  to  headache,  what  shall  we 
do  ?     And  suppose  that  tonics  do  not  help  to 
make  exertion  easy,  and  that  the  great  tonic  of 
change  of  air  fails  us,  shall  we  still  persist?  And 
here  lies   the   trouble  :    there   are  women  who 
mimic  fatigue,  who  indulge  themselves  in  rest  on 
the  least  pretence,  who  have  no  symptoms  so 
truly  honest  that  we  need  care  to  regard  them. 
These  are  they  who  spoil  their  own  nervous  sys- 
tems as  they  spoil  their  children,  when  they  have 
them,  by  yielding  to  the  least  desire  and  teaching 
them  to  dwell  on  little  pains.     For  such  people 
there  is  no  help  but  to  insist  on  self-control  and 
on  daily  use  of  the  limbs.     They  must  be  told  to 
exert  themselves,  and  made  to  do  so  if  that  can 


REST.  65 

be.  If  they  are  young,  this  is  easy  enough.  K 
they  have  grown  to  middle  life,  and  created 
habits  of  self-indulgence,  the  struggle  is  often 
useless.  But  few,  however,  among  these  women 
are  free  from  some  defect  of  blood  or  tissue, 
either  original  or  acquired  as  a  result  of  years  of 
indolence  and  attention  to  aches  and  ailments 
which  should  never  have  had  given  to  them  more 
than  a  passing  thought,  and  which  certainly 
should  not  have  been  made  an  excuse  for  the 
sofa  or  the  bed. 

Sometimes  the  question  is  easy  to  settle.  If 
you  find  a  woman  who  is  in  good  condition  as 
to  color  and  flesh,  and  who  is  always  able  to  do 
what  it  pleases  her  to  do,  and  who  is  tired  by 
what  does  not  please  her,  that  is  a  woman  to 
order  out  of  bed  and  to  control  with  a  firm  and 
steady  will.  That  is  a  woman  who  is  to  be  made 
to  walk,  with  no  regard  to  her  complaints,  and 
to  be  made  to  persist  until  exertion  ceases  to 
give  rise  to  the  mimicry  of  fatigue.  In  such 
cases  the  man  who  can  insure  belief  in  his  opin- 
ions and  obedience  to  his  decrees  secures  very 
often  most  brilliant  and  sometimes  easy  success ; 
and  it  is  in  such  cases  that  women  who  are  in  all 
other  ways  capable  doctors  fail,  because  they  do 


56  ^^'^^• 

not  obtain  the  needed  control  over  those  of  their 
own  sex.  I  have  been  struck  with  this  a  num- 
ber of  times,  but  I  have  also  seen  that  to  be  too 
long  and  too  habitually  in  the  hands  of  one  phy- 
sician, even  the  wisest,  is  for  some  cases  of  hys- 
teria the  main  difficulty  in  the  way  of  a  cure, — it 
is  so  easy  to  disobey  the  familiar  friendly  attend- 
ant, so  hard  to  do  this  where  the  physician  is  a 
stranger.  But  we  all  know  well  enough  the  per- 
sonal value  of  certain  doctors  for  certain  cases. 
Mere  hygienic  advice  will  win  a  victory  in  the 
hands  of  one  man  and  obtain  no  good  results  in 
those  of  another,  for  we  are,  after  all,  artists  who 
all  use  the  same  means  to  an  end  but  fail  or  suc- 
ceed according  to  our  method  of  using  them. 
There  are  still  other  cases  in  which  mischievous 
tendencies  to  repose,  to  endless  tire,  to  hysteri- 
cal symptoms,  and  to  emotional  displays  have 
grown  out  of  defects  of  nutrition  so  distinct  that 
no  man  ought  to  think  for  these  persons  of  mere 
exertion  as  a  sole  means  of  cure.  The  time 
comes  for  that,  but  it  should  not  come  until  en- 
tire rest  has  been  used,  with  other  means,  to  fit 
them  for  making  use  of  their  muscles.  Nothing 
upsets  these  cases  like  over-exertion,  and  the  at- 
tempt to  make  them  walk  usually  ends  in  some 


REST.  57 

miscliievous  emotional  display,  and  in  creating  a 
new  reason  for  thinking  that  they  cannot  walk. 
As  to  the  two  sets  of  cases  just  sketched,  no  one 
need  hesitate;  the  one  must  walk,  the  other 
should  not  until  we  have  bettered  her  nutritive 
state.  She  may  be  able  to  drag  herself  about, 
but  no  good  will  be  done  by  making  her  do  so 
But  between  these  two  classes,  and  allied  by 
certain  symptoms  to  both,  lie  the  larger  number 
of  such  cases,  giving  us  every  kind  of  real  and 
imagined  symptom,  and  dreadfully  well  fitted  to 
puzzle  the  most  competent  physician.  As  a  rule, 
no  harm  is  done  by  rest,  even  in  such  people  as 
give  us  doubts  about  whether  it  is  or  is  not  well 
for  them  to  exert  themselves.  There  are  plenty 
of  these  women  who  are  just  well  enough  to 
make  it  likely  that  if  they  had  motive  enough 
for  exertion  to  cause  them  to  forget  themselves 
they  would  find  it  useful.  In  the  doubt  I  am 
rather  given  to  insisting  on  rest,  but  the  rest  I 
like  for  them  is  not  at  all  their  notion  of  rest 
To  lie  abed  half  the  day,  and  sew  a  little  and 
read  a  little,  and  be  interesting  as  invalids  and 
excite  sympathy,  is  all  very  well,  but  when  they 
are  bidden  to  stay  in  bed  a  month,  and  neither  to 
read,  write,  nor  sew,  and  to  have  one  nurse, — 


58  REST. 

who  is  not  a  relative, — then  repose  becomes  for 
some  women  a  rather  bitter  medicine,  and  they 
are  glad  enough  to  accept  the  order  to  rise  and  go 
about  when  the  doctor  issues  a  mandate  which  has 
become  pleasantly  welcome  and  eagerly  looked 
for.  I  do  not  think  it  easy  to  make  a  mistake  in 
this  matter  unless  the  woman  takes  with  morbid 
delight  to  the  system  of  enforced  rest,  and  unless 
the  doctor  is  a  person  of  feeble  will.  I  have 
never  met  myself  with  any  serious  trouble  about 
getting  out  of  bed  any  woman  for  whom  I 
thought  rest  needful,  but  it  has  happened  to 
others,  and  the  man  who  resolves  to  send  any 
nervous  woman  to  bed  must  be  quite  sure  that 
she  will  obey  him  when  the  time  comes  for  her 
to  get  up. 

I  have,  of  course,  made  use  of  every  grade  of 
rest  for  my  patients,  from  insisting  upon  repose 
on  a  lounge  for  some  hours  a  day  up  to  entire 
rest  in  bed.  In  carrying  out  my  general  plan  of. 
treatment  in  extreme  cases  it  is  my  habit  to  ask 
the  patient  to  remain  in  bed  from  six  weeks  to 
two  months.-  At  first,  and  in  some  cases  for  four 
or  five  weeks,  I  do  not  permit  the  patient  to  sit 
up,  or  to  sew  or  write  or  read,  or  to  use  the  hands 
in   any   active  way  except  to  clean   the   teeth. 


REST.  59 

"Where  at  first  the  most  absolute  rest  is  desirable, 
I  arrange  to  have  the  bowels  and  water  passed 
while  lying  down,  and  the  patient  is  lifted  on  to 
a  lounge  for  an  hour  in  the  morning  and  again 
at  bedtime,  and  then  lifted  back  again  into  the 
newly-made  bed.  In  most  cases  of  weakness, 
treated  by  rest,  I  insist  on  the  patient  being  fed 
by  the  nurse,  and,  when  well  enough  to  sit  up  in 
bed,  I  insist  that  the  meats  shall  be  cut  up,  so  as 
to  make  it  easier  for  the  patient  to  feed  herself. 

In  many  cases  I  allow  the  patient  to  sit  up  in 
order  to  obey  the  calls  of  nature,  but  I  am  al- 
ways careful  to  have  the  bowels  kept  reasonably 
free  from  costiveness,  knowing  well  how  such  a 
state  and  the  efforts  it  gives  rise  to  enfeeble  a  sick 
person. 

The  daily  sponging  bath  is  to  be  given  by  the ' 
nurse,  and  should  be  rapidly  and  skilfully  done. 
It  may  follow  the  first  food  of  the  day,  the  early  \ 
milk,  or  cocoa,  or  coffee,  or,  if  preferred,  may  be 
used  before  noon,  or  at  bedtime,  which  is  found 
in  some  cases  to  be  best  and  to  promote  sleep. 

For  some  reason,  the  act  of  bathings  or  even 
the  being  bathed,  is  mysteriously  fatiguing  to 
certain  invalids,  and  if  so  I  have  the  general 
sponging  done  for  a  time  but  thrice  a  week. 


60  REST. 

Most  of  these  patients  suffer  from  use  of  the 
eyes,  and  this  makes  it  needful  to  prohibit  read- 
ing and  writing,  and  to  have  all  correspondence 
carried  on  through  the  nurse.  But  many  neuras- 
thenic people  also  suffer  from  being  read  to,  or, 
in  other  words,  from  any  prolonged  effort  at 
attention.  In  these  cases  it  will  be  found  that  if 
the  nurse  will  read  the  morning  paper,  and  as 
she  does  so  relate  such  news  as  may  be  of  in- 
terest, the  patient  will  bear  it  very  well,  and  will 
by  degrees  come  to  endure  the  hearing  of  such 
reading  as  is  already  more  or  less  familiar. 

Usually,  after  a  fortnight  I  permit  the  patient 
to  be  read  to, — one  to  three  hours  a  day, — but  I 
am  daily  amazed  to  see  how  kindly  nervous  and 
anaemic  women  take  to  this  absolute  rest,  and 
how  little  they  complain  of  its  monotony.  In 
fact,  the  use  of  massage  and  the  battery,  with 
the  frequent  comings  of  the  nurse  with  food,  and 
the  doctor's  visits,  seem  so  to  fill  up  the  day  as 
to  make  the  treatment  less  tiresome  than  might 
be  supposed.  And,  besides  this,  the  sense  of 
comfort  which  is  apt  to  come  about  the  fifth  or 
sixth  day, — the  feeling  of  ease,  and  the  ready 
capacity  to  digest  food,  and  the  growing  hope 
of  final  cure,  fed  as  it  is  by  present  relief, — all 


REST.  61 

conspire  to  make  most  patients  contented  and 
tractable. 

The  intelligent  and  watchful  physician  must, 
of  course,  know  how  far  to  enforce  and  when 
to  relax  these  rules.  When  it  is  needful,  as  it 
sometimes  is,  to  prolong  the  state  of  rest  to  two 
or  three  months,  the  patient  may  need  at  the 
close  occupation  of  some  kind,  and  especially 
such  as,  while  it  does  not  tax  the  eyes, -gives 
the  hands  something  to  do,  the  patient  being, 
we  suppose,  by  this  time  able  tQ  sit  up  in  bed 
during  a  part  of  the  day. 

The  moral  uses  of  enforced  rest  are  readily 
estimated.  From  a  restless  life  of  irregular 
hours,  and  probably  endless  drugging,  from 
hurtful  sympathy  and  over-zealous  care,  the 
patient  passes  to  an  atmosphere  of  quiet,  to 
order  and  control,  to  the  system  and  care  of  a 
thorough  nurse,  to  an  absence  of  drugs,  and  to 
simple  diet.  The  result  is  always  at  first,  what- 
ever it  may  be  afterwards,  a  sense  of  relief,  and 
a  remarkable  and  often  a  quite  abrupt  disap- 
pearance of  many  of  the  nervous  symptoms  with 
which  we  are  all  of  us  only  too  sadly  familiar. 

All  the  moral  uses  of  rest  and  isolation  and 

change  of  habits   are   not  obtained   by  merely 

6 


62  REST. 

insisting  on  the  physical  conditions  needed  to 
effect  these  ends.  If  the  physician  has  the  force 
of  character  required  to  secure  the  confidence 
and  respect  of  his  patients,  he  has  also  much 
more  in  his  power,  and  should  have  the  tact  to 
seize  the  proper  occasions  to  direct  the  thoughts 
of  his  patients  to  the  lapse  from  duties  to  others, 
and  to  the  selfishness  which  a  life  of  invalidism 
is  apt  to  bring  about.  Such  moral  medication 
belongs  to  the  higher  sphere  of  the  doctor's 
duties,  and,  if  he  means  to  cure  his  patient  per- 
manently, he  cannot  afford  to  neglect  them. 
Above  all,  let  him  be  careful  that  the  masseuse 
and  the  nurse  do  not  talk  of  the  patient's  ills,  and 
let  him  by  degrees  teach  the  sick  person  how 
very  essential  it  is  to  speak  of  her  aches  and 
pains  to  no  one  but  himself. 

I  have  often  asked  myself  why  rest  is  of  value 
in  the  cases  of  which  I  am  now  speaking,  and 
I  have  already  alluded  briefly  to  some  of  the 
modes  in  which  it  is  of  use. 

Let  us  take  first  the  simpler  cases.  We  meet 
'now  and  then  with  feeble  people  who  are  dys- 
peptic, and  who  find  that  exercise  after  a  meal, 
or  indeed  much  exercise  on  any  day,  is  sure  to 
cause  loss  of  power  or  lessened  power  to  digest 


REST.  63 

food.  The  same  thing  is  seen  in  an  extreme 
degree  in  the  well-known  experiment  of  causing 
a  dog  to  ran  violently  after  eating,  in  which  case 
digestion  is  entirely  suspended.  "Whether  these 
results  be  due  to  the  calling  oiF  of  blood  from 
the  gastric  organs  to  the  muscles,  or  whether  the 
nervous  system  is,  for  some  reason,  unable  to 
evolve  at  the  same  time  the  force  needed  for  a 
double  purpose,  is  not  quite  clear,  but  the  fact 
is  undoubted,  and  finds  added  illustrations  in 
many  of  the  class  of  exhausted  women.  It  is 
plain  that  this  trouble  exists  in  some  of  them. 
It  is  likely  that  it  is  present  in  a  larger  number. 
The  use  of  rest  in  these  people  admits  of  no 
question.  If  we  are  to  give  them  the  means  in 
blood  and  flesh  of  carrying  on  the  work  of  life, 
it  must  be  done  with  the  aid  of  the  stomach,  and 
we  must  humor  that  organ  until  it  is  able  to  act 
in  a  more  healthy  manner  under  ordinary  con- 
ditions. 

I  am  often  asked  how  I  can  expect  by  such  a 
system  to  rest  the  organs  of  mind.  I^o  act  of 
will  can  force  them  to  be  at  rest.  To  this  I 
should  answer  that  it  is  not  the  mere  half-auto- 
matic intellectuation  which  is  harmful  in  men  or 
women  subject  to  states  of  feebleness  or  neuras- 


64  REST. 

thenia,  and  that  the  systematic  vigorous  use  of 
mind  on  distinct  problems  is  within  some  form 
of  control.  It  is  thought  with  the  friction  of 
worry,  which  injures,  and,  unless  we  can  secure 
an  absence  of  this,  it  is  in  vain  to  hope  for  help 
by  the  method  I  am  describing.  The  man  har- 
assed by  business  anxieties,  the  woman  with 
morbidly-developed  or  ungoverned  maternal  in- 
stincts, will  only  illustrate  the  causes  of  failure. 
Perhaps  in  all  dubious  cases  Dr.  Playfair's  rule 
is  not  a  bad  one,  to  consider,  and  to  let  the 
patient  consider,  this  mode  of  treatment  as  a  hope- 
ful experiment,  which  may  have  to  be  abandoned, 
and  which  is  valueless  without  the  cordial  and 
submissive  assistance  of  the  patient. 

The  muscular  system  in  many  of  such  patients 
— I  mean  in  ever-weary,  thin  and  thin-blooded 
persons — is  doing  its  work  with  constant  diffi- 
culty. As  a  result,  fatigue  comes  early,  is  ex- 
treme, and  lasts  long.  The  demand  for  nutritive 
aid  is  ahead  of  the  supply,  or  else  the  supply  is 
incompetent  as  to  quality,  and  before  the  tissues 
are  rebuilded  a  new  demand  is  made,  so  that 
the  materials  of  disintegration  accumulate,  and 
\  do  this  the  more  easily  because  the  eliminative 
organs  share  in  the  general  defects.     And  these 


REST.  65 

are  some  of  the  reasons  why  angemic  people  are 
always  tired;  but,  besides  this,  all  real  sensa- 
tions are  magnified  by  women  whose  nervous 
systems  have  become  sensitive  owing  to  a  life  of 
attention  to  their  ailments,  and  so  at  last  it  be- 
comes hard  to  separate  the  true  from  the  false, 
and  we  are  thus  led  to  be  too  sceptical  as  to  the 
presence  of  real  causes  of  annoyance.  Certain 
it  is  that  rest,  under  proper  conditions,  is  found 
by  such  sufferers  to  be  a  great  relief;  but  rest 
alone  will  not  answer,  and  it  is  needful,  as  I  shall 
show,  to  bring  to  our  help  certain  other  means, 
in  order  to  secure  all  the  good  which  repose  may 
be  made  to  insure. 

In  dealing  with  this,  as  with  every  other 
medical  means,  it  is  well  to  recall  that  in  our 
attempts  to  help  we  may  sometimes  do  harm, 
and  we  must  make  sure  that  in  causing  the 
largest  share  of  good  we  do  the  least  possible 
evil. 

"  The  one  goes  with  the  other,  as  shadow 
with  light,  and  to  no  therapeutic  measure  does 
this  apply  more  surely  than  to  the  use  of  rest. 

"Let  us  take  the  simplest  case, — that  which 

arises  daily  in  the  treatment  of  joint-troubles  or 

broken  bones.     We  put  the  limb  in  splints,  and 
e  6* 


QQ  BEST. 

•  thus,  for  a  time,  check  its  power  to  move.  The 
bone  knits,  or  the  joint  gets  well ;  but  the 
muscles  waste,  the  skin  dries,  the  nails  may  for 
a  time  cease  to  grow,  nutrition  is  brought  down, 
as  an  arithmetician  would  say,  to  its  lowest 
terms,  and  when  the  bone  or  joint  is  well  we 
have  a  limb  which  is  in  a  state  of  disease.  As 
concerns  broken  bones,  the  evil  may  be  slight 
and  easy  of  relief,  if  the  surgeon  will  but  re- 
member that  when  joints  are  put  at  rest  too  long 
they  soon  fall  a  prey  to  a  form  of  arthritis,  which 
is  the  more  apt  to  be  severe  the  older  the  patient 
is,  and  may  be  easily  avoided  by  frequent  motion 
of  the  joints,  which,  to  be  healthful,  exact  a  cer- 
tain share  of  daily  movement.  If,  indeed,  with 
perfect  stillness  of  the  fragments  we  could  have 
the  full  life  of  a  limb  in  action,  I  suspect  that  the 
cure  of  the  break  might  be  far  more  rapid. 

"  What  is  true  of  the  part  is  true  of  the  whole. 

When  we  put  the  entire  body  at  rest  we  create 

certain  evils  while  doing  some  share  of  good, 

and  it  is  therefore  our  part  to  use  such  means  as 

i  shall,  in  every  case,  lessen  and  limit  the  ills  we 

(  cannot  wholly  avoid.     How  to  reach  these  ends 

I  I  shall  by  and  by  state,  but  for  a  brief  space  I 

'  should  like  to  dwell  on  some  of  the  bad  results 


REST.  67 

which  come  of  our  efforts  to  reach  through  rest 
in  bed  all  the  good  which  it  can  give  us,  and  to 
these  points  I  ask  the  most  thoughtful  attention, 
because  upon  the  care  with  which  we  meet  and 
provide  for  them  depends  the  value  which  we 
will  get  out  of  this  most  potent  means  of  treat- 
ment. 

"  When  we  put  patients  in   bed   and  forbid ' 
them  to  rise  or  to  make  use  of  their  muscles, 
we  at  once  lessen  appetite,  weaken  digestion  inj 
many  cases,  constipate  the  bowels,  and  enfeeble 
circulation."^ 

When  we  put  the  muscles  at  absolute  rest  ■ 
we  create  certain  difficulties,  because  the  normal 
acts  of  repeated  movement  insure  a  certain  rate 
of  nutrition  which  brings  blood  to  the  active 
parts,  and  without  which  the  currents  flow  more 
largely  around  than  through  the  muscles.  The 
lessened  blood-supply  is  a  result  of  diminished 
functional  movement,  and  we  need  to  create  a 
constant  demand  in  the  inactive  parts.  But,  be- 
sides this,  every  active  muscle  is  practically  a 
throbbing  heart,  squeezing  its  vessels  empty 
while  in  motion,  and   relaxing,  so   as  to  allow 

^Soguin  Lecture,  op.  cif. 


68  REST. 

them  to  fill  up  anew.  Thus,  both  for  itself  and 
in  its  relations  to  the  areolar  spaces  and  to  the 
rest  of  the  body,  its  activity  is  functionally  of 
service.  Then,  also,  the  vessels,  unaided  by 
changes  of  posture  and  by  motion,  lose  tone,  and 
the  distant  local  circuits,  for  all  of  these  reasons, 
cease  to  receive  their  normal  supply,  so  that  de- 
fects of  nutrition  occur,  and,  with  these,  defects 
of  temperature. 

"  I  was  struck  with  the  extent  to  which  these 
evils  may  go,  in  the  case  of  Mrs.  P.,  set.  52,  who 
was  brought  to  me  from  Kew  Jersey,  having 
been  in  bed  fifteen  years.  I  soon  knew  that 
she  was  free  of  grave  disease,  and  had  stayed 
in  bed  at  first  because  there  was  some  lack  of 
power  and  much  pain  on  rising,  and  at  last 
because  she  had  the  firm  belief  that  she  could 
not  walk.  After  a  wreck's  massage  I  made 
her  get  up.  I  had  won  her  full  trust,  and  she 
obeyed,  or  tried  to  obey  me,  like  a  child.  But 
she  would  faint  and  grow  deadly  pale,  even  if 
seated  a  short  time.  The  heart-beats  rose  from 
sixty  to  one  hundred  and  thirty,  and  grew  fee- 
ble; the  breath  came  fast,  and  she  had  to  lie 
down  at  once.  Her  skin  was  dry,  sallow,  and 
bloodless,  her  muscles  flabby ;  and  when,  at  last, 


REST.  69 

after  a  fortnight  more,  I  set  her  on  her  feet 
again,  she  had  to  endure  for  a  time  the  most 
dreadful  vertigo  and  alarming  palpitations  of  the 
heart,  while  her  feet,  in  a  few  minutes  of  feeble 
walking,  would  swell  so  as  to  present  the  most 
strange  appearance.  By  and  by  all  this  went 
away,  and  in  a  month  she  could  walk,  sit  up, 
sew,  read,  and,  in  a  word,  live  like  others.  She 
went  home  a  well-cured  woman. 

"  Let  us  think,  then,  when  we  put  a  person  in 
bed,  that  we  are  lessening  the  heart-beats  some 
twenty  a  minute,  nearly  a  third;  that  we  are 
causing  the  tardy  blood  to  linger  in  the  by-ways 
of  the  blood-round,  for  it  has  its  by-ways ;  that 
rest  in  bed  binds  the  bowels,  and  tends  to  de- 
stroy the  desire  to  eat ;  and  that  muscles  at  rest 
too  long  get  to  be  unhealthy  and  shrunken  in 
substance.  Bear  these  ills  in  mind,  and  be 
ready  to  meet  them,  and  we  shall  have  answered 
the  hard  question  of  how  to  help  by  rest  without 
hurt  to  the  patient." 

"When  I  first  made  use  of  this  treatment  I 
allowed  my  patients  to  get  up  too  suddenly,  and 
in  some  cases  I  thus  brought  on  relapses  and  a 
return  of  the  feeling  of  painful  fatigue.  I  also 
saw  in  some  of  these  cases  what  I  still  see  at 


70  REST. 

times  under  like  circumstances, — a  rapid  loss  of 
flesh. 

I  now  begin  by  permitting  the  patient  to  sit 
up  in  bed,  then  to  feed  herself,  and  next  to  sit 
up  out  of  bed  a  few  minutes  at  bedtime.  In  a 
week,  she  is  desired  to  sit  up  fifteen  minutes 
twice  a  day,  and  this  is  gradually  increased  until, 
at  the  end  of  six  to  twelve  weeks,  she  rests  on 
the  bed  only  three  to  five  hours  daily.  Even 
after  she  moves  about  and  goes  out,  I  insist  for 
two  months  on  absolute  repose  at  least  two  or 
three  hours  daily. 

The  use  of  a  hammock  is  found  by  some 
people  to  be  a  very  agreeable  change  from  the 
bed  during  a  part  of  the  day. 


CHAPTER   YL 


MASSAGE. 


How  to  deprive  rest  of  its  evils  is  the  subject 
with  which  I  might  very  well  have  labelled  this 
chapter.  I  have  pointed  out  what  I  mean  by 
rest,  how  it  hurts,  and  how  it  seems  to  help ; 
and,  as  I  believe  that  it  is  useful  in  most  cases 
only  if  employed  in  conjunction  with  other 
means,  the  study  of  these  becomes  of  the  first 
importance. 

The  two  aids  which  by  degrees  I  learned  to 
call  upon  with  confidence  to  enable  me  to  use 
rest  without  doing  harm  are  massage  and  elec- 
tricity. "We  have  first  to  deal  with  massage,  and 
I  willingly  give  to  it  a  chapter  of  careful  detail, 
because  as  yet  it  is  little  understood  in  America, 
and  because  I  have  some  facts  to  relate  in  regard 
to  it  which  are  not  known,  I  think,  on  either 
side  of  the  Atlantic. 

Massage  in  some  form  has  long  been  in  use  in 

the  East,  and  is  well  known  as  the  lommi-lommi 

71 


72  MASSAGE. 

of  the  slothful  inhabitants  of  the  Sandwich 
Islands.  In  Japan  it  is  reserved  as  an  occupa- 
tion for  the  blind,  whose  delicate  sense  of  feel- 
ing might,  I  should  think,  very  well  fit  them  for 
this  task.  It  is,  however,  in  these  countries  less 
used  in  disease  than  as  the  luxury  of  the  rich ; 
nor  can  I  find  in  the  few  books  on  the  subject 
that  it  has  been  resorted  to  habitually  as  a  tonic 
in  Europe,  or  otherwise  than  as  a  means  of 
treating  local  disorders. 

It  is  many  years  since  I  first  saw  in  this  city 
general  massage  used  by  a  charlatan  in  a  case 
of  progressive  paralj'sis.  The  temporary  results 
he  obtained  were  so  remarkable  that  I  began 
soon  after  to  employ  it  in  locomotor  ataxia,  in 
which  it  sometimes  proved  of  signal  value,  and 
in  other  forms  of  spinal  and  local  disease.  At 
first  I  had  to  train  nurses  to  use  it,  but  I  soon 
found  that,  although  it  was  of  some  service  to 
their  patients,  no  one  could  use  massage  well 
who  was  not  continually  engaged  in  doing  it. 
Some  men  do  it  better  than  any  woman ;  but 
I  prefer,  nevertheless,  for  obvious  reasons,  to 
reserve  men  for  male  patients. 

A  few  years  later  I  resorted  to  it  in  the  first 
cases  which  I  treated  by  rest,  and  I  very  soon 


MASSAGE.  73 

found  that  I  had  in  it  an  agent  little  understood 
and  of  singular  utility. 

It  will  be  necessary,  in  pursuance  of  my  plan, 
to  describe  exactly  how  this  means  is  employed, 
and  why  it  is  employed. 

I  can  better  speak  of  what  it  does  after  care- 
fully specifying  the  manner  of  its  use. 

After  a  few  days  of  the  milk  diet,  with  which 
my  treatment  ordinarily  begins,  or  from  the  out- 
set, the  masseur  or  masseuse  is  set  to  work.  An 
hour  is  chosen  midway  between  two  meals,  and, 
the  patient  lying  in  bed,  the  manipulator  starts 
at  the  feet  and  gently  but  firmly  seizes  the  skin, 
rolling  it  lightly  between  his  fingers  and  going 
carefully  over  the  whole  foot ;  then  the  toes  are 
bent  and  moved  about  in  every  direction,  and 
next,  with  the  thumbs  and  fingers,  the  little 
muscles  of  the  foot  are  kneaded  more  largely, 
and  the  interosseous  groups  worked  at  with  the 
finger-tips  between  the  bones.  At  last  the 
whole  tissues  of  the  foot  are  seized  with  both 
hands  and  somewhat  firmly  rolled  about.  !N'ext 
the  ankles  are  dealt  with  in  like  fashion,  all  the 
crevices  between  the  articulating  bones  being 
sought  out  and  kneaded,  while  the  joint  is  put  in 
every  possible  position.     The  leg  is  next  treated, 


74  MASSAGE. 

first  as  to  the  skin,  then  hy  deeper  grasping 
of  the  areolax  tissue,  and  last  by  industrious 
and  more  profound  pinching^  of  the  large  mus- 
cular masses,  which  for  this  purpose  are  put  in 
a  position  of  the  utmost  relaxation.  The  grasp 
of  the  muscles  should  be  firm,  and  for  the  large 
muscles  of  the  calf  and  thigh  both  hands  should 
act  together,  the  masses  of  muscle  being,  as  it 
were,  twisted  around  the  bone  while  the  hands 
alternately  contract  upon  them.  In  treating  the 
firm  muscles  in  front  of  the  leg,  the  fingers  or 
the  two  thumbs  are  made  to  roll  the  muscle 
under  the  cushions  of  the  finger-tips.  At  brief 
intervals  the  manipulator  seizes  the  limb  in  both 
hands  and  lightly  runs  the  grasp  upw^ards,  so  as 
to  favor  the  flow  of  venous  blood-currents,  and 
then  returns  to  the  kneading  of  the  muscles. 

The  same  process  is  carried  on  in  every  part 
of  the  body,  and  especial  care  is  given  to  the 
muscles  of  the  loins  and  spine,  while  usually  the 
face  is  not  touched.    The  abdomen  is  first  treated 

1  The  word  "  pinch"  is  here  used  for  lack  of  a  better.  It  is, 
oddly  enough,  associated  in  the  minds  of  many  persons  with 
the  idea  of  pain,  which,  of  course,  is  not  borne  out  by  its  true 
meaning.  The  process  here  described  is  such  as  I  have  seen 
used  by  one  of  the  most  skilful  of  masseurs. 


MASSAGE.  75 

by  pinching  the  skin,  then  by  deeply  grasping 
and  rolling  the  muscular  walls  in  the  hands,  and 
at  last  the  entire  belly  is  kneaded  with  the  heel 
of  the  hand  in  a  succession  of  rapid,  deep  move- 
ments, passing  around  in  the  direction  of  the 
colon,  while  somewhat  later  the  whole  belly, 
relaxed  by  position,  may  be  shaken  by  a  rapid 
motion  of  the  grasping  hands. 

Pinching  or  squeezing  of  the  skin  is  very 
valuable  in  certain  spinal  troubles  accompanied 
with  lessened  sensation,  and  in  some  other  cases, 
if  the  surface  and  extremities  be  very  cold; 
but  the  best  masseurs  often  omit  it  and  rely 
solely  upon  the  deeper  grip  and  rolling  of  the 
muscles.  The  process  should  not  be  painful  or 
more  at  first  than  merely  annoying  and  fa- 
tiguing, but  after  a  time  the  muscles  may  be 
handled  with  a  good  deal  of  strength  without 
causing  other  than  agreeable  results.  If  the 
grip  be  allowed  to  move  much  or  roughly  over 
the  skin,  the  pull  upon  the  hairs  will  inevitably 
cause  troublesome  and  painful  boils.  In  fact, 
unless  the  process  be  well  done,  it  is  best  in  very 
hairy  persons  to  shave  the  legs ;  but  with  prac- 
tised operators  this  is  always  needless,  or  may 
be  avoided  by  using  cocoa-oil  or  vaseline.    These, 


76.  MASSAGE. 

however,  make  the  work  less  efficient  and  more 
difficult,  and  I  do  not  order  them  unless  it  is 
considered  desirable  to  rub  into  the  system  some 
oleao;inous  material.^ 

Too  much  care  cannot  be  used  to  cover  with 
stockings  and  warm  wraps  the  parts  after  in  turn 
they  have  been  subjected  to  massage.  As  to  time, 
at  first  the  massage  should  last  half  an  hour,  but 
should  be  increased  in  a  week  to  a  full  hour.  I 
observe  that  Dr.  Playfair  has  it  used  twice  a  day 
or  more,  and  I  have  since  had  it  so  employed  in 
some  cases,  letting  the  masseuse  come  before 
noon,  and  allowing  the  nurse  to  use  it  at  night 
if  it  does  not  interfere  with  sleep,  which  is  a 
matter  to  be  tested  solely  by  experiment.  Com- 
monly, one  hour  suffices.  I  was  at  one  time  in 
the  habit  of  suspending  the  use  of  both  massage 
and  electricity  during  menstruation,  because  I 
found  occasionally  that  these  agents  disturbed  or 
checked  the  normal  flow.  Of  late,  however,  I 
continue  the  employ  of  both  agents,  but  confine 
them  to  the  limbs.  I  have  met  with  rare  cases 
in  which   almost  any  massage  gave   rise   to   a 


^  Cocoa-oil  is  cheap,  and  keeps  well  if  covered  with  lime- 
water  ;  it  is  also  agreeable  in  odor. 


MASSAGE.  77 

uterine  hemorrliage,  and  in  which  the  utmost 
caution  became  necessary. 

"Women  who  have  a  sensitive  abdominal  sur- 
face or  ovarian  tenderness  have  of  course  to  be 
handled  with  care,  but  in  a  few  days  a  practised 
rubber  will  by  degrees  intrude  upon  the  tender 
regions,  and  will  end  by  kneading  them  with  all 
desirable  force.  The  same  remarks  apply  to  the 
spine  when  it  is  hurt  by  a  touch ;  and  it  is  very 
rare  indeed  to  find  persons  whose  irritable  spots 
cannot  at  last  be  rubbed  and  kneaded  to  their 
permanent  profit. 

Occasionally  I  meet  with  feeble  persons  as  to 
whom  the  masseurs  remark  that  they  "  rub  wet," 
— that  is,  under  massage  they  perspire  remarka- 
bly. If  the  case  proves  successful,  this  peculiarity 
soon  passes  away. 

The  daily  massage  is  kept  up  through  at  least , 
six  weeks,  and  then,  if  everything  seems  to  me  '] 
to  be  going  along  well,  I  direct  the  rubber  or 
nurse  to  spend  half  of  the  hour  in  exercising 
the  limbs  as  a  preparation  for  walking.  This 
is  done  after  the  Swedish  plan,  by  making  very 
slowly  passive  and  extreme  extensions  and  flex- 
ions of  the  limbs  for  a  few  days,  then  assisted 

movements,  next  active  unassisted  movements, 

7* 


78  MASSAGE. 

and  last  active   movements   gently  resisted   by 

I  nurse  or  masseuse.     When  able  to  sit  and  stand, 

it  is  well  to  keep  up  and  extend  the  number  of 

\  these  gentle  gymnastic  acts  and  to  encourage  the 

patient  to  make  them  habitual.^ 

At  the  seventh  week  massage  is  used  on  alter- 
nate days,  and  is  commonly  laid  aside  when  the 
patient  gets  up  and  begins  to  move  about. 

During  the  past  year,  several  of  the  members 
of  the  staff  of  the  Infirmary  for  !N"ervous  Dis- 
ease, and  especially  my  colleague,  Dr.  Wharton 
Sinkler,  have  obliged  me  by  studying  with  care 
the  influence  of  massage  on  temperature,  and  as 
to  this  some  very  interesting  results  have  been 
obtained.  In  general,  when  a  highly  hysterical 
person  is  rubbed,  the  legs  are  apt  to  grow  cold 
under  the  stimulation,  and  if  this  continues  to 
be  complained  of  it  is  no  very  good  omen  of 
the  ultimate  success  of  the  treatment.  But  usu- 
ally in  a  few  days  a  change  takes  place,  and  the 
limbs  all  grow  warm  when  kneaded,  as  happens 
in  most  people  from  the  beginning  of  the  treat- 
ment.    The  extremely  low  temperature  of  the 


1  Some  care  is  needed  not  to  overwork  patients.     For  do- 
tails  I  must  refer  to  manuals  of  Swedish  Gymnastics. 


MASSAGE.  79 

limbs  of  cliildren  suffering  with  so-called  essen- 
tial paralysis  is  well  known.  I  have  frequently 
seen  these  strangely  cold  parts  rise,  under  an 
hour's  massage,  six  to  ten  degrees  F.  In  such 
small  limbs,  the  long  contact  of  a  warm  hand  i 
may  account  for  at  least  a  part  of  this  notable 
rise  in  temperature.  In  adults  this  can  hardly 
be  looked  upon  as  a  cause  of  the  rise  of  tem- 
perature produced  by  massage,  first,  because  the 
long  exposure  of  large  surfaces  incident  to  the 
process  is  calculated  to  lessen  whatever  in- 
crease of  heat  the  contact  of  the  hand  may 
cause,  and  secondly,  because  this  rise  is  a  very 
variable  quantity,  and  because  occasionally  some 
other  and  less  comprehensible  factors  actually 
induce  a  fall  rather  than  a  rise  in  the  ther- 
mometer as  a  result  of  massage. 

In  very  nervous  or  hysterical  women,  ignorant 
of  what  the  act  of  kneading  may  be  expected  to 
bring  about,  and  especially  in  such  as  are  thin  and 
anaemic  and  have  either  a  somewhat  high  or  an 
unusually  low  normal  temperature,  we  may  find 
at  first  a  slight  fall  of  the  thermometer,  then  a 
fairly  constant  rise,  with  some  irregularities,  and 
at  last,  as  the  health  improves,  a  lessening  effect 
or  none  at  all. 


go  MASSAGE. 

I  The  most  notable  rise  is  to  be  found  in  per- 
kons  who,  owing  to  some  organic  disease,  have 
(acquired  liability  to  great  changes  of  tempera- 
Ture. 

It  is  impossible  to  observe  the  increase  of  heat 
which  follows  both  massage  and  electricity  with- 
^out  inferring  that  these  agents  must  for  a  time, 
like  exercise  and  other  tonics,  increase  the  tissue- 
waste  by  the  stimulus  they  cause  of  the  general 
and  interstitial  circulations,  and  by  the  direct 
influence  they  seem  to  have  on  the  tissues  them- 
selves. I  have  sought  to  study  this  matter  care- 
fully by  placing  patients  on  a  fixed  and  com- 
petent diet  of  milk  alone,  and  by  estimating  the 
waste  of  tissues  as  shown  in  the  secretions  before 
and  after  the  use  of  massage.  This  study  is  as 
yet  too  incomplete  for  full  statement,  but  so  far 
it  would  seem  that  massage  does  not  much  alter 
the  total  elimination  of  the  entire  day,  but  causes 
a  large  and  abrupt  increase  within  three  hours, 
followed  by  a  compensatory  decline. 

I  add  a  number  of  tables,  which  very  well 
illustrate  the  facts  above  stated  as  to  rise  of 
temperature. 

Mrs.  J.,  at  rest,  on  the  usual  diet.  Manipu- 
lation at  11,  daily : 


MASSAGE. 


81 


Before  Massage.  After  Massage. 

100 100 

100 100| 

99| 99^ 

99f 100 

99| 100 

100 100 

99^ 100 

99|  .......  100 


Miss  P.,  set.  24,  hysteria  : 


Before  Massage.  After  Massage. 

99| 99J 

98^ 99 

98i 99 

98| 99 

98^  .......    98| 

99 99f 

100^    . lOOf 

lOOf .  lOlf 

lOOf lOOf 

lOOf •   .  100 


Mrs.   L.,  a  very  thin,   feeble,   and   bloodless 
woman,  set.  29  years  : 


Before  Massage.  After  Massage. 

99 100 

98| 99^ 

98 98| 

99 100 

/ 


i 


32  MASSAGE. 

Before  Massage.  After  Massaga 

98f 98f 

99  ...       .    .    .    99| 

100 100^ 

99 99| 

Mrs.  P.,  set.  31,  feeble  and  ansemic,  nervous, 
slight  albuminuria  and  chronic  bronchitis.  Li- 
able to  fever.     3  p.m. 

Before  Massage.  After  Massage. 

lOlf 102 

100 lOOf 

99 99| 

100 101 

^    99| 100^ 

99f 100| 

lOOf lOlf 

lOOf 99f 


>       lOOf lOOf 

lOOxV I00j\ 

99i 99| 


t;^        These  temperatures  were  taken  always  before 
V   j  4   P.M.,  and   at  intervals   of  three   days.      Her 
morning  temperature  was  usually  99°  to  99|-°, 
and  in  the  evening,  9  to  10  o'clock,  it  always 
rose  to  100°,  101°,  and  at  times  to  102°. 
y       As  I  have  said  already,  there  are  persons  who, 
lunder  circumstances  seemingly  alike,  have  from 


MASSAGE.  33 

massage  a  large  rise  of  temperature,  and  others 
who  experience  none.  I  give  a  single  case  of 
what  is  rare  but  not  exceptional, — an  almost 
constant  fall  of  temperature. 

Miss  ]Sr.,  set.  21,  hysteria,  good  condition  : 

Before  Massage.  After  Massage. 

98  .......  97f 

981 98i 

98 98 

98| 98 

98f 98 

These  facts  are,  of  course,  extremely  interest- 
ing ;  but  it  is  well  to  add  that  the  success  of 
the  treatment  is  not  indicated  in  any  constant 
way  by  the  thermal  changes,  which  are  neither 
so  steady  nor  so  remarkable  as  those  caused  by 
electricity. 

If  now  we  ask  ourselves  why  massage  does  \ 
good  in  cases  of  absolute  rest,  the  answer — at 
least  a  partial  answer — ^is  not  difficult.  The 
secretions  of  the  skin  are  stimulated  by  the 
treatment  of  that  tissue,  and  it  is  visibly  flushed, 
as  it  ought  to  be,  from  time  to  time,  by  ordi- 
nary active  exercise.  Under  massage  the  flabby 
muscles  acquire  a  certain  firmness,  which  at  first 
lasts  only  for  a  few  minutes,  but  which  after  a 


84  MASSAGE. 

itime  is  more  enduring  -and  ends  by  becoming 
I  permanent.    The  firm  grasp  of  the  manipulator's 
hand  stimuhites  the  muscle,  and,  if  sudden,  may 
cause  it  to  contract  sensibly,  which,  however,  is 
j  not  usually  desirable  or  agreeable.     The  muscles 
are  by  these  means  exercised  without  the  use  of 
volitional  exertion  or  the  aid  of  the  nervous  cen- 
tres, and  at  the  same  time  the  alternate  grasp  and 
relaxation  of  the  manipulator's  hands  squeezes 
out  the  blood  and  allows  it  to  flow  back  anew, 
•^  thus  healthfully  exciting  the  vessels  and  increas- 
ing mechanically  the  flow  of  blood  to  the  tissues 
which  they  feed. 

Although  this  plan  of  acting  on  the  muscles 
seems  to  dispense  with  any  demands  upon  the 
centres,  it  is  not  to  be  supposed  that  it  is  alto- 
-gether  without   influence    on   these   parts.      In 
fact,  extreme  use  of  massage  occasionally  flushes 
the  face  and  causes  sense  of  fulness  in  the  head 
,  or  ache  in  the  back.     Moreover,  in  some  spinal 
^  maladies  it  has  effects  not  to  be  altogether  ex- 
plained  by   its   mechanical   stimulation   of   the 
i  muscles,  nerves,  and  skin. 
The  visible  results  as  regards  the  surface-cir- 
.  culation  are  sufficiently  obvious,  and   most  re- 
markably  so    in    persons    who,   besides    being 


MASSAGE.  35 

ansemic  and  thin,  have  heen  long  unused  to  exer- 
cise. After  a  few  treatments  the  nails  become 
pink,  the  veins  show  where  before  none  were 
to  be  seen,  the  larger  vessels  grow  fuller,  and 
the  whole  tint  of  the  limbs  chans-es  for  the 
better. 

In  like  manner  the  sore  places  which  previ-( 
ously  existed,  or  which  are  brought  into  sensi- 
tive prominence  by  the  manipulation,  by  degrees 
cease  to  be  felt,  and  a  general  sensation  of  com- 
fort and  ease  follows  the  later  treatments. 

I  am  accustomed  to  pay  a  good  deal  of  atten- 
tion to  the  observations  made  as  to  these  and 
other  points  by  practised  manipulators,  and  I 
find  that  their  daily  familiarity  with  every  detail 
of  the  color,  warmth,  and  firmness  of  the  tissues 
is  often  of  great  use  to  me. 


CHAPTER   YIL 


ELECTRICITY. 


Electricity  is  the  second  means  which  I  have 
made  use  of  for  the  purpose  of  exercising  mus- 
cles in  persons  at  rest.  It  has  also  an  additional 
value,  of  which  I  shall  presently  speak.    . 

In  order  to  exercise  the  muscles  best  and  with 
the  least  amount  of  pain  and  annoyance,  we 
make  use  of  an  induction  current,  with  interrup- 
tions as  slow  as  one  in  every  two  to  five  seconds, 
a  rate  readily  obtained  in  properly-constructed 
batteries.^  This  plan  is  sure  to  give  painless 
exercise,  but  it  is  less  rapid  and  less  complete 
as  to  the  quality  of  the  exercise  caused  than  the 
movements  evolved  by  vp.ry  rapid  in»terruptions. 
These,  in  the  hands  of  a  clever  operator  who 
knows  his  anatomy  well,  are  therefore,  on  the 
whole,  more  satisfactory,  but  they  require  some 
experience  to  manage  them  so  as  not  to  shock 

^  Most  induction  batteries  are  without  any  arrangement  for 

making  infrequent  breaks  in  the  current. 
86 


ELECTRICITY.  87 

and  disgust  the  patient  by  inflicting  needless 
pain.  The  poles,  covered  with  sponges  well 
wetted  with  salt  water,  are  placed  on  each  mus- 
cle in  turn,  and  kept  about  four  inches  apart. 
They  are  moved  fast  enough  to  allow  of  the 
muscles  being  well  contracted,  which  is  easily 
managed,  and  with  sufficient  speed,  if  the  assist- 
ant be  thoroughly  acquainted  with  the  points  of 
Ziemssen.  After  the  legs  are  treated,  the  mus- 
cles of  the  belly  and  back  and  loins  are  gone 
over  systematically,  and  finally  those  of  the  chest 
and  arms.  The  face  and  neck  are  neglected. 
About  forty  minutes  to  an  hour  are  needed; 
but  at  first  a  less  time  is  employed.  The  gen- 
eral result  is  to  exercise  in  tarn  all  the  external 
muscles.^ 

1^0  such  obvious  and  visible  results  are  seen 
as  we  observe  after  massage,  but  the  thermal 
changes  are  much  more  constant   and  remark- 


^  In  the  extreme  constipation  of  certain  hysterical  women, 
good  may  be  done  by  placing  one  conductor  in  the  rectum 
and  moving  the  other  over  the  abdomen  so  as  to  cause  full 
movement  of  the  muscles.  This  means  must  at  first  be 
employed  cautiously,  and  the  amount  of  electricity  carefully 
increased. 


88 


ELECTRICITY. 


able,  and  show  at  least  that  we  are  not  dealing 
with  an  agent  which  merely  amuses  the  patient 
or  acts  alone  through  some  mysterious  influence 
on  the  mental  status. 

A  half-hour's  treatment  of  the  muscles  com- 
monly gives  rise  to  a  marked  elevation  of  tem- 
perature, which  fades  away  within  an  hour  or 
two.  This  effect  is,  like  that  from  massage, 
most  notable  in  persons  liable  to  fever  from 
some  organic  trouble,  and  it  varies  as  to  its 
degree  in  individuals  who  have  no  such  disease. 

The  first  case,  Miss  B.,  set.  20,  is  an  example 
of  tubercular  disease  of  the  apex  of  the  right 
lung.  She  had  a  morning  temperature  of  98J° 
to  99J°,  and  an  evening  temperature  of  100°  to 
102^ 

Electricity  was  used  about  11  o'clock  daily, 
with  these  results : 

Before  Electricity.  After  Electricity. 


November  25  . 

.  99 

99f 

"    27  .    . 

.    .  97f 

100 

"    28 . 

.  98 

99 

"    29  . 

.    .  98| 

99| 

December  2  . 

.    .  lOOi 

lOlf 

'»    4  .    . 

.    .  99^ 

100^ 

"    5  .   . 

.    .  99f 

99^ 

Mrs.  R.,  set.  40,  the  next  case,  was  merely  a 


ELECTRICITY. 


89 


rather  anaemic,  feeble,  and  thin  woman,  who  for 
years  had  not  been  able  to  endure  any  prolonged 
effort.  She  got  well  under  the  general  treat- 
ment, gaining  thirteen  pounds  on  a  weight  of 
ninety-eight  pounds,  her  height  being  five  feet 
and  one  inch.  The  facts  as  to  rise  of  tempera- 
ture are  most  remarkable,  and,  I  need  not  say, 
were  carefully  observed,  the  observations  having 
been  made  by  Dr.  Sinkler. 

Temperature  taken  in  the  mouth  while  at  rest 
in  bed. 

Before  Electricity.  After  Electricity. 


April  2 

.    .  98| 

981 

"  3 

.    .  98i 

98| 

u     4 

.    .98^ 

98| 

"  5 

.  98 

98| 

*'  6 

.   .  97^ 

98,^ 

u     7 

.   .  98 

98^ 

"  8 

.  98 

98f 

"  9 

.  98 

99^ 

«'  10 

.   .  98f 

98f 

"  11 

.    .  98^^^ 

98tV 

"  12 

.    .  98f 

99tV 

"  13 

.    .  98i 

99^ 

"  14 

.  98| 

99i 

"  16 

.  98^4^ 

99^ 

«  17 

.  98^ 

99x% 

"  18 

.  98xV 

99,2jr 

«  19 

.  98^ 

99^ 

One  hour  later,  99^ 


8* 


90 

ELECTRICITY, 

Before  Electricity.  After  Electri 

April 

20 

.     99                          99iV 

(( 

21 

.         .     98^                  99^2^ 
Menstrual  period. 

(( 

30 

.     98|                    98f 

May 

1 

.     98                      98^5^ 

(( 

2 

.     98                     98x8^ 

The  third  case,  Miss  M.,  set.  33,  was  that  of 
a  pallid  woman,  the  daughter  of  a  well-known 
physician  in  the  South.  She  suffered  for  six 
years  with  "  nervous  exhaustion,"  headaches, 
pain  in  the  back,  intense  depression  of  spirits, 
nausea,  and  repeated  attacks  of  hysteria.  She 
slept  only  under  anodynes,  and  used  stimulants 
freely.  Under  the  use  of  rest  and  the  adju- 
vant treatment  described.  Miss  M.  made  a 
thorough  recovery,  and  was  restored  to  useful 
active  life. 

Miss  M.     Thermometer  held  in  mouth. 

Before  Electricity.  After  Electricity. 


May  U 

.    99,,V 

99J^  -»  Menstruating ;  general  fara- 
99^   /     dization  only. 

"     15 

.     99 

"     16 

.     99^ 

99|^      Gen'l  faradization  and  limbs 

u     17 

.     98f 

99i 

"     18 

.     98| 

99i 

''     19 

.     98i 

98| 

"    21 

.     983 

99 

»    22 

.     98f 

99tV 

ELECTRICITY. 


91 


Before  Electricity.  After  Electricity. 


May  25 

.     98^V 

98A 

"    26 

.     98tV 

99tV 

»    29 

.     98f 

99 

"     30 

.     98x% 

99tV 

"     31 

.     98f^ 

99xV 

Mrs.  P.,  set.  38,  was  a  rather  nervous  woman, 
easily  tired,  but  not  ansemic  and  not  very  thin. 
She  improved  greatly  under  the  treatment. 


Before  Electricity.  After  Electricity. 


January  27 
"  29 
"  30 
"      31 

February  1 

February  8 
9 
10 
12 
13 
U 
15 
19 
20 
23 
24 
27 
28 


984 


99i 
98| 
99 


99i 
99i 
99f 
99| 
99f. 


Thermometer  in  axilla  ten 
minutes  before  and  after. 


Menstrual  period. 


98f 

98f 

98| 

98i 

98| 

98f 

98| 

99 

98 

98| 

99 

99i 


99i 

99 

99 


99 

98f 

98f 

98f 

99 

99| 

99| 


99| 


Thermometer  in  mouth  five 
minutes  before  and  after. 


Menstrual  period. 


92 


ELECTRICITY. 


Before  Electricity.  After  Electricity. 
March     13        .     99  99f 

"         14        .     98|  98f 

"        15        .     99  99^ 

Miss  K.,  8et.  27,  was  a  fair  case  of  hysterical 
conditions;  over-use  of  chloral  and  bromides; 
anorexia  and  loss  of  flesh  and  color. 

Thermometer  in  mouth. 


Before  Electricity. 
May  15        .100 
"    16         .     100 
u    17 


After  Electricity. 


"  18 

"  19 

May  20 

"  22 

"  26 

"  27 

"  28 

"  29 

"  30 

"  31 

June  2 

u  4 

"  6 

"  7 


lOOi 


98| 
99| 

99| 

99rV 
99^ 
99§ 

99x% 

99tV 

99t\t 

99| 

99^ 

99A 

99xV 


100 
100 
lOOf 


98| 
lOO^V 


1 


100 

99| 
oq  6 

99x17 
99f 

99x^3 
99x1^ 
99t% 
99| 

99x«Ty 
99x^^ 
99^ 


General  faradization  for  fif- 
teen minutes. 

General  faradization,  fif- 
teen minutes,  also  of  arm 
muscles,  twenty  minutes. 

General  faradization,  ten 
minutes ;  arms  and  legs, 
twenty  minutes. 


I  have  given  these  full  details  because  I  have 


ELECTRICITY.  93 

not  seen  elsewhere  any  statement  of  the  rather 
remarkable  phenomena  which  they  exemplify. 
It  may  be  that  a  part  at  least  of  the  thermal 
change  is  due  to  the  muscular  action,  although 
this  seems  hardly  competent  to  account  for  any 
large  share  in  the  alteration  of  temperature,  and 
we  must  look  further  to  explain  it  fully.  ]N"o 
mental  excitement  can  be  called  upon  as  a  cause, 
since  it  continues  after  the  patient  is  perfectly 
accustomed  to  the  process.  I  should  add,  also, 
that  in  most  cases  the  subject  of  the  experiment 
was  kept  in  ignorance  of  the  fact  that  a  rise  of 
the  thermometer  was  to  be  expected.  Is  it  not 
possible  that  the  current  even  of  an  induction 
battery  has  the  power  so  to  stimulate  the  tissues 
as  to  cause  an  increase  in  the  ordinary  rate  of 
disintegrative  change?  Perhaps  a  careful  study 
of  the  secretions  might  lend  force  to  this  sugges- 
tion. That  the  muscular  action  produced  by  the 
battery  is  not  essential  to  the  increase  of  bodily 
heat  is  shown  by  the  next  set  of  facts  to  which  I 
desire  to  call  attention. 

Some  years  ago,  Messrs.  Beard  and  Kockwell 
stated  that  when  an  induced  current  is  used  for 
fifteen  to  thirty  minutes  daily,  one  pole  on  the 
neck  and  one  on  either  foot,  or  alternately  on 


94  ELECTRICITF. 

both,  the  persistent  use  of  this  form  of  treatment 
is  decidedly  tonic  in  its  influence.  I  believe 
that  in  this  opinion  they  were  perfectly  correct, 
and  I  am  now  able  to  show  that,  when  thus 
employed,  the  induced  current  causes  also  a  de- 
cided rise  of  temperature  in  many  people,  which 
proves  at  least  that  it  is  in  some  way  an  active 
agent,  capable  of  positively  infl.uencing  the  nutri- 
tive changes  of  the  body. 

The  rise  of  temperature  thus  caused  is  less 
constant,  as  well  as  less  marked,  than  that  occa- 
sioned by  the  muscle  treatment.  I  do  not  think 
it  necessary  to  give  the  tables  in  full.  They 
show  in  the  best  cases  rises  of  one-fifth  to  four- 
fifths  of  a  degree  F.,  and  were  taken  with  the 
utmost  care  to  exclude  all  possible  causes  of 
error. 

The  mode  of  treatment  is  as  follows :  At  the 
close  of  the  muscle-electrization  one  pole  is 
placed  on  the  nape  of  the  neck  and  one  on  a 
foot  for  fifteen  minutes.  Then  the  foot  pole  is 
shifted  to  the  other  foot  and  left  for  the  same 
length  of  time. 

The  primary  current  is  used,  as  being  less 
painful,  and  the  interruptions  are  made  as  rapid 
as  possible,  while  the  cylinder  or  control  wires 


ELECTRICITY.  95 

are  adjusted  so  as  to  give  a  current  which  is  not 
uncomfortable. 

It  is  desirable  to  have  electricity  used  by  a 
practised  hand,  but  of  late  I  have  found  that  in- 
telligent nurses  may  suffice,  and  this,  of  course, 
materially  lessens  the  cost.  In  very  timid  or 
nervous  people,  or  those  who  at  some  time  have 
been  severely  ''  shocked"  by  the  application  of 
electricity  in  the  hands  of  charlatans,  it  is  com- 
mon to  find  the  patient  greatly  dreading  a  return 
to  its  use.  In  this  case,  if  the  battery  be  started 
and  th.e  poles  moved  about  on  the  surface  as 
usual,  but  without  any  connection  being  made,; 
one  of  two  things  will  happen, — either  the  patient 
will  find  it  naturally  very  mild,  and  will  submit 
fearlessly  to  a  gentle  and  increasing  treatment,  or 
else  her  apprehensions  will  so  dominate  her  as  to! 
cause  her  to  complain  of  the  effects  as  exciting 
or  tiring  her,  or  as  spoiling  her  sleep.  A  few 
words  of  kindly  explanation  will  suffice  to  show 
her  how  much  expectation  has  to  do  with  the 
apparent  results,  and  she  will  be  found,  if  the 
matter  be  managed  with  tact,  to  have  learned  a 
lesson  of  wide  usefulness  throughout  her  treat- 
ment. 

I  have  been  asked  very  often  if  all  the  means 


96  ELECTRICITY. 

here  described  be  necessary,  and  I  have  been 
\  criticised  by  some  of  the  reviewers  of  my  first 
edition  because  I  had  not  pointed  out  the  relative 
needfulness  of  the  various  agencies  employed. 
In  fact,  I  have  made  very  numerous  clinical 
studies  of  cases,  in  some  of  which  I  used  rest, 
seclusion,  and  massage,  and  in  others  rest,  seclu- 
sion, and  electricity.  It  is,  of  course,  difficult, 
I  may  say  impossible,  to  state  in  any  numerical 
manner  the  reason  for  my  conclusion  in  favor 
of  the  conjoined  use  of  all  these  means.  If  one 
is  to  be  left  out,  I  have  no  hesitation  in  saying 
that  it  should  be  electricity. 


CHAPTER   YIIL 

DIETETICS   AND   THERAPEUTICS. 

The  somewliat  wearisome  and  minute  details 
I  have  given  as  to  seclusion,  rest,  massage,  and 
electricity  have  prepared  the  wslj  for  a  discus- 
sion of  the  dietetic  and  medicinal  treatment 
which  without  them  would  be  neither  possible 
nor  useful. 

As  to  diet,  we  have  to  be  guided  somewhat  by 
the  previous  condition  and  history  of  the  patient. 

It  is  difficult  to  treat  any  of  these  cases  without 
a  resort  at  some  time  more  or  less  to  the  use  of 
milk.  In  most  dyspeptic  cases — and  few  neuras- 
thenic women  fail  to  be  obstinately  dyspeptic^ 
milk  given  at  the  outset,  and  given  alone  by 
Karell's  method  for  a  fortnight  or  less,  enor- 
mously simplifies  our  treatment.  Even  after 
that,  milk  is  the  best  and  most  easily  managed 
addition  to  a  general  diet.  As  to  its  use  with 
rest  and  massage  as  an  exclusive  diet  in  obesity 
alone  or  in  extreme  fatness  with  anaemia,  I  spoke 

E        ^r  9  97 


98  DIETETICS  AND    THERAPEUTICS. 

in  a  former  edition  with  a  confidence  which  has 
been  increased  by  the  added  experience  of  phy- 
sicians on  both  sides  of  the  Atlantic.     Finally, 
there  are  exceptional  cases  of  intestinal  pain  of 
obscure  parentage  or  seemingly  neuralgic,  of  dys- 
pepsia incorrigible  by  other  treatments,  which, 
having  resulted  in  grave  general  defects  of  nu- 
trition, are  best  treated  by  several  weeks  of  milk 
diet,  combined  with  rest,  massage,  and  electricity. 
Milk,  therefore,  must  be  so  much  used  in  these 
cases  in  connection  with  the  general  treatment 
I  am  describing  that   it    is  perhaps  as  well  to 
say  more  clearly  how  it  is  to  be  employed  when 
given  alone  or  with  other  food.     I  am  the  more 
willing  to  do  this  because  I  have  learned  within 
two  years  certain  facts  as  to  the  effects  of  milk 
diet  which  have,  I  believe,  hitherto  escaped  ob- 
servation.    In  fact,  the  study  of  the  therapeutic 
influence  and  full  results  of  exclusive  diets  is  yet 
to  be  made ;  nor  can  I  but  believe  that  accurate 
dietetics  will  come  to  be  a  far  more  useful  part 
of  our  means  of  managing  certain  cases  than  as 
yet  seems  possible. 

We  are  indebted  chiefly  to  Dr.  Karell,  of  St. 
Petersburg,  for  our  knowledge  of  the  value  of 
milk  as  an  exclusive  diet,  and  to  Dr.  Donkin  for 


DIETETICS  AND    THERAPEUTICS,  99 

tlie  extension  of  Karell's  treatment  to  diabetes. 
I  shall  formulate  as  curtly  as  possible  the  rules 
to  be  followed  in  using  milk  as  an  exclusive  diet 
in  dj^speptic  states,  and  in  anseraia  with  obesity, 
and  in  the  latter  state  uncomplicated  by  defec- 
tive hsemic  conditions. 

For  fuller  statements  as  to  the  reasons  for  the 
various  rules  to  be  observed  in  using  milk,  I 
must  refer  the  reader  to  Karell's  paper  and  to 
Donkin's  book. 

Have  the  utmost  care  used  as  to  preservation  i 
of  the  milk  employed,  and  as  to  the  perfect 
cleansing  of  all  vessels  in  which  it  is  kept.  Use  \ 
well-skimmed  milk,  as  fresh  as  can  be  had,' 
and,  if  possible,  let  it  be  obtained  from  the  cow 
twice  a  day.  At  first  the  skimming  should  be 
thorough,  and  for  the  treatment  of  dyspepsia 
or  albuminuria  the  milk  must  be  as  creamless 
as  possible.  The  milk  of  the  common  cow  is, 
for  our  purposes,  preferable  to  that  of  the  Al- 
derney.  It  may  be  used  warm  or  cold,  but, 
except  in  rare  cases  of  diarrhoea,  should  not  be 
boiled. 

It  ought  to  be  given  at  least  every  two  hours  ; 
at  first,  in  quantities  not  to  exceed  four  ounces, 
and  as  the  amount  taken  is  enlarged,  the  periods 


100  DIETETICS  AND   THERAPEUTICS. 

between  may  be  lengthened,  but  not  beyond 
three  hours  during  the  waking  day,  the  last 
dose  to  be  used  at  bedtime  or  near  it.  If  the 
patient  be  wakeful,  a  glass  should  be  left  within 
reach  at  night,  and  always  its  use  should  be  re- 
sumed as  early  as  possible  in  the  morning.  A 
little  lime-water  may  be  added  to  the  night 
milk,  to  preserve  it  sweet,  and  it  should  be  kept 
covered. 

The  milk  given  during  the  day  should  be  taken 
at  set  times,  and  very  slowly  sipped  in  mouthfuls ; 
and  this  is  an  important  rule  in  many  cases. 
Where  it  is  so  disagreeable  as  to  cause  great  dis- 
gust or  nausea,  the  addition  of  enough  of  tea  or 
coffee  or  caramel  or  salt  to  merely  flavor  it  may 
enable  us  to  make  its  use  bearable,  and  we 
may  by  degrees  abandon  these  aids.  Another 
plan,  rarely  needed,  is  to  use  milk  with  the  gen- 
eral diet  and  lessen  the  latter  until  only  milk  is 
employed.  If  these  rules  be  followed,  it  is  rare 
to  find  milk  causing  trouble ;  but  if  its  use  give 
rise  to  acidity,  the  addition  of  alkalies  or  lime- 
water  may  help  us,  or  these  may  be  used  and  the 
milk  scalded  by  adding  a  fourth  of  boiling  water 
to  the  milk,  which  has  been  previously  put  in 
a   warm   glass.      Some   patients   digest   it  best 


DIETETICS  AND   THERAPEUTICS.  IQl 

when  it  has  the  addition  of  a  teaspoonful  of 
barley-  or  rice-water  to  each  ounce,  the  main 
object  being  to  prevent  the  formation  of  large, 
firm  clots  in  the  stomach. 

When  used  as  an  exclusive  diet,  skimmed 
milk  gives  rise  to  certain  very  interesting  and 
what  I  might  call  normal  symptoms.  Since  at 
first  we  can  rarely  give  enough  to  sustain  the 
functions,  for  several  days  the  patient  is  apt  to 
lose  weight,  which  is  another  reason  why  ex- 
ercise is  in  such  cases  undesirable.  This  loss 
soon  ceases,  and  in  the  end  there  is  usually  a 
gain,  while  in  most  rest  cases  an  exclusive  milk 
diet  may  be  dispensed  with  after  a  week.  Where 
milk  is  taken  alone  for  weeks  or  months,  it  is 
common  enough  to  observe  a  large  increase  in 
bodily  weight. 

During  the  first  week  or  two,  exclusive  milk 
diet  gives  rise  to  a  marked  sense  of  sleepiness. 
It  causes  nearly  always,  and  even  for  weeks  of 
its  use,  a  white  and  thick  fur  on  the  tongue,  and 
often  for  a  time  an  unpleasant  sweetish  taste  in 
the  early  morning,  neither  of  which  need  be 
regarded.  Intense  constipation  and  yellowish 
stools  of  a  peculiar  odor  are  usual.  Of  the 
former  I  shall  speak  in  connection  with  the  use 

9^ 


102  DIETETICS  AND    THERAPEUTICS. 

of  milk  in  special  cases.  The  influence  of  milk 
on  the  urinary  secretion  is  more  remarkable,  and 
has  not  been  as  yet  fully  studied. 

There  is,  of  course,  a  large  flow  of  urine ;  and 
in  dropsical  cases  due  to  renal  maladies  this  may 
exceed  the  ingested  fluid  and  carry  away  very 
rapidly  the  dropsical  accumulations.  It  is  some- 
times annoying  to  nervous  persons  because  of 
the  frequent  micturition  it  makes  necessary.  I 
have  discovered  that  while  alone  skimmed  milk 
is  being  taken,  uric  acid  usually  disappears  al- 
most entirely  from  the  urine,  so  that  it  is  difli- 
cult  to  discover  even  a  trace  of  this  substance ; 
nor  does  it  seem  to  return  so  long  as  nothing  but 
creamless  milk  is  used.  Almost  any  large  addi- 
tion of  other  food,  but  especially  of  meat,  enables 
us  to  find  it  asrain.  Creatine  and  creatinine  also 
seem  to  lessen  in  amount,  but  of  the  extent  of 
this  change  I  am  not  as  yet  fully  informed. 

A  yet  more  singular  alteration  occurs  as  to  the 
pigments.  If  after  a  fortnight  or  less  of  exclusive 
milk  diet  we  fill  with  the  urine  a  long  test-tube, 
and,  placing  it  beside  a  similar  tube  of  the  ordi- 
nary urine  of  an  adult,  look  down  into  the  two 
tubes,  we  shall  observe  that  the  milk  urine  has  a 
singular  greenish  tint,  which  once  seen  cannot 


DIETETICS  AND    THERAPEUTICS.  103 

again  be  mistaken.  If  we  put  some  of  this  urine 
in  a  test-tube  carefully  upon  hot  nitric  acid,  there 
is  noticed  none  of  the  usual  brown  hue  of  ox- 
idized pigment  at  the  plane  of  contact.  In 
fact,  it  is  often  difficult  to  see  where  the  two 
fluids  meet. 

The  precise  nature  of  this  greenish-yellow 
pigment  is  now  a  matter  under  study,  but  so 
far  it  seems  clear  at  least  that  during  a  diet  of 
milk  the  ordinary  pigments  of  the  urine  disap- 
pear or  are  singularly  modilied.  A  single  meal 
of  meat  will  at  once  cause  their  return  for  a 
time. 

These  results  have  been  carefully  re-examined 
at  my  request  by  Dr.  Marshall  in  the  Laboratory 
of  the  University  of  Pennsylvania,  and  his  re- 
sults and  my  own  have  been  found  to  accord; 
while  he  has  also  discovered  that  during  the  use 
of  milk  the  substances  which  give  rise  to  the 
ordinary  faecal  odors  disappear,  and  are  replaced 
by  others  the  nature  of  which  is  not  as  yet 
fully  comprehended.  The  changes  I  have  here 
pointed  out  are  remarkable  indications  of  the 
vast  alterations  in  assimilation  and  in  the  de- 
struction of  tissues  which  seem  to  take  place 
under  the  influence  of  this  peculiar  diet.     Some 


104  DIETETICS  AND    THERAPEUTICS. 

of  them  may  account  for  its  undoubted  value 
in  lithsemic  or  gouty  states;  but,  at  all  events, 
they  point  to  the  need  for  a  more  exhaustive 
study  both  of  this  and  of  other  methods  of 
exclusive  diet. 

As  regards  milk,  enough  has  here  been  said  to 
act  as  a  guide  in  its  practical  use  in  the  class  of 
cases  with  which  we  are  now  concerned ;  but  I 
may  add  that  it  is  sometimes  useful,  as  the  case 
progresses,  to  employ  in  place  of  milk,  or  with 
it,  some  one  of  the  various  '^  children's  foods," 
such  as  Kestle's  food  or  that  of  the  Anglo-Swiss 
Company. 

Before  dealing  with  the  treatment  of  the  anae- 
mic and  feeble  and  more  or  less  wasted  invalids 
who  require  treatment  by  rest  and  its  concomi- 
tant aids,  I  desire  to  say  a  few  words  as  to  the 
use  of  rest,  milk  dietetics,  and  massage  in  people 
who  are  merely  cumbrously  loaded  with  adipose 
tissues,  and  also  in  the  very  small  class  of  anaemic 
women  who  are  excessively  fat  and  may  or  may 
not  be  hysterical,  but  are  apt  to  be  feeble  and 
otherwise  wretched. 

Karell  has  pointed  out  that  on  creamless  milk 
diet  fat  people  lose  flesh;  and  this  is  true;  so 
that  sometimes  this  mode  of  lessening  weight 


DIETETICS  AND    THERAPEUTICS.  105 

succeeds  very  well.  But  it  does  not  always 
answer,  because,  as  in  Banting,  loss  of  weight  is 
apt  to  be  accompanied  with  loss  of  strength,  so 
that  in  some  cases  the  results  are  disastrous,  or  at 
least  alarming.  I  do  not  know  that  this  is  ever 
the  case  if  the  directions  of  Mr.  Harvey^  are  fol- 
lowed with  care  and  the  weight  very  deliber- 
ately lessened.  But  for  this  few  people  have  the 
patience ;  and,  even  if  they  can  be  induced  to  fol- 
low out  a  strict  diet,  it  is  often  useful  to  be  able 
to  cut  off  very  rapidly  a  large  amount  of  weight, 
and  so  shorten  the  period  of  strict  regimen,  or 
at  least  put  over-fat  persons  in  a  condition  to 
exercise  with  a  freedom  which  had  become  diffi- 
cult, and  thus  to  provide  them  with  a  healthful 
means  of  preventing  an  accumulation  of  adipose 
matter.  This  can  be  done  rapidly  and  with  safety 
by  the  following  means.  The  person  whose 
weight  we  decide  to  lessen  is  placed  on  skimmed 
milk  alone,  with  the  usual  precautions;  or  at 
once  we  give  skimmed  milk  with  the  usual  food, 
and  in  a  week  put  aside  all  other  diet  save  milk 
and  all  other  fluids.  "When  we  find  what  quantity 
of  milk  will  sustain  the  weight,  we  diminish  the 

^  Harvey  on  Corpulence. 


106  DIETETICS  AND    THERAPEUTICS. 

amount  by  degrees  until  the  patient  is  losing  a 
half-pound  of  weight  each  day,  or  less  or  more, 
as  seems  to  be  well  borne.  Meanwhile,  during 
the  first  week  or  two  rest  in  bed  is  enjoined, 
and  later  for  a  varying  period  rest  in  bed  or 
on  a  lounge  is  insisted  upon,  while  at  the  same 
time  massage  is  used  once  or  twice  a  day,  and 
later  in  the  case  Swedish  movements.  At  the 
same  time,  the  pulse  and  weight  are  observed 
with  care,  so  that  if  there  be  too  rapid  loss,  or 
any  sign  of  feebleness,  the  diet  may  be  increased. 
In  many  such  cases  I  allow  daily  a  moderate 
amount  of  beef-  or  chicken-  or  oyster-soup, — 
more  as  a  relief  to  the  unpleasantness  of  a  milk 
diet  than  for  any  other  reason. 

When  the  weight  has  been  sufficiently  lowered, 
we  add  to  the  diet  beef,  mutton,  oysters,  etc., 
and  finally  arrange  a  full  diet  list  to  include  but 
a  moderate  amount  of  hydro-carbons.  Mean- 
while, the  milk  remains  as  a  large  part  of  the 
food,  and  the  active  Swedish  movements  are  still 
kept  up  as  a  habit,  the  patient  being  directed  by 
desrrees  to  add  the  usual  forms  of  exercise. 

If  we  attempt  to  make  so  speedy  a  change  in 
weight  while  the  patient  is  afoot,  the  loss  is  apt 
to  be  gravely  felt ;  but  with  the  precautions  here 


DIETETICS  AND    THERAPEUTICS.  ]07 

advised  it  is  interesting  "and  pleasant  to  see  how 
great  a  reduction  may  be  made  in  a  reasonable 
time  without  annoyance  and  with  no  obvious  re- 
sult except  a  gain  in  health  and  comfort. 

Cases  of  ansemia  in  women  with  excess  of 
flesh  have  to  be  managed  in  a  somewhat  similar 
fashion,  but  with  the  utmost  care.  In  such 
persons  we  have  a  loss  of  red  blood-globules, 
perhaps  imperfect  blood-pigment,  weak  heart, 
rapid  pulse,  and  general  feebleness,  with  too 
much  fat,  but  not,  or  at  least  rarely,  extreme  obe- 
sity. The  milder  cases  may  profit  by  iron,  with 
rest  and  very  vigorous  massage,  but  in  old  cases 
of  this  kind — they  are,  happily,  rare— the  best 
plan  is  to  put  the  patient  at  rest,  to  use  mas- 
sage, restrict  the  diet  to  skimmed  milk,  or  to 
milk  and  broths  free  from  fat,  and  with  them, 
when  the  weight  has  been  sufficiently  lowered, 
to  give  iron  freely,  and  by  degrees  a  good  general 
diet,  under  which  the  globules  rise  in  number,  so 
that  even  with  a  new  gain  in  flesh  there  comes 
an  equal  gain  in  strength  and  comfort.  As  to 
other  details,  the  management  should  be  much 
the  same  as  that  which  I  shall  presently  describe 
in  connection  with  cases  of  another  kind. 

I  add  two  cases  in  illustration  of  the  use  of 


108  DIETETICS  AND    THERAPEUTICS. 

rest,  milk,  and  massage  in  the  treatment  of  per- 
sons who  are  both  anaemic  and  overloaded  with 
fat. 

Mrs.  P.,  set.  45,  weight  one  hundred  and 
ninety  pounds,  height  five  feet  four  and  a  half 
inches,  had  for  some  years  been  feeble,  unable 
to  walk  without  panting,  or  to  move  rapidly 
even  a  few  steps.  Although  always  stout,  her 
great  increase  of  flesh  had  followed  an  attack 
of  typhoid  fever  four  years  before.  Her  appear- 
ance was  strikingly  suggestive  of  anaemia. 

She  was  subject  to  constant  attacks  of  acid 
dyspepsia,  was  said  to  be  unable  to  bear  iron  in 
any  form,  and  had  not  menstruated  for  seven 
months.  She  had  no  uterine  disease,  and  was 
not  pregnant.  Two  years  before  I  saw  her  she 
had  been  made  very  ill  owing  to  an  attempt  to 
reduce  her  flesh  by  too  rapid  Banting,  and  since 
then,  although  not  a  gross  or  large  eater,  she 
had  steadily  gained  in  weight,  and  as  steadily  in 
discomfort. 

She  was  kept  in  bed  for  five  weeks.  Mas- 
sage was  used  at  first  once  daily,  and  after  a 
fortnight  twice  a  day,  while  milk  was  given,  and 
in  a  week  made  the  exclusive  diet.  Her  average 
of  loss  for  thirty  days  was  a  pound  a  day,  and  the 


DIETETICS  AND    THERAPEUTICS.  109 

diet  was  varied  bj  the  addition  of  broths  after  the 
third  week,  so  as  to  keep  the  reduction  within 
safe  limits.  Her  pulse  at  first  w^as  90  to  100  in 
the  morning,  and  at  night  80  to  95,  her  tempera- 
ture being  always  a  half  degree  to  a  degree  below 
the  normal.  At  the  third  week  the  latter  was  as 
is  usual  in  health,  and  the  pulse  had  fallen  to 
80  in  the  morning,  and  80  to  90  at  night. 

After  two  weeks  I  gave  her  the  lactate  of  iron 
every  three  hours  in  full  doses.  In  the  fourth 
week  additions  were  made  to  her  diet-list,  and 
Swedish  movements  were  added  to  the  massage, 
which  was  applied  but  once  a  day ;  and  during 
the  fifth  w^eek  she  began  to  sit  up  and  move 
about.  At  the  seventh  week  her  pulse  was  70 
to  80,  her  temperature  natural,  and  her  blood- 
globules  much  increased  in  number.  Her  weight 
had  now  fallen  to  one  hundred  and  forty-five 
pounds,  and  her  appearance  had  decidedly  im- 
proved. She  left  me  after  three  and  a  half  months, 
able  to  walk  with  comfort  three  miles.  She  has 
lived,  of  course,  with  care  ever  since,  but  writes 
me  now,  after  two  years,  that  she  is  a  well  and 
vigorous  woman.  Her  periodical  flow  came  back 
^YQ  months  after  her  treatment  began,  and  she 

has  since  had  a  child. 

10 


110  DIETETICS  AND    THERAPEUTICS. 

Early  in  the  spring  of  1876,  Mrs.  C,  set.  40, 
came  under  my  care  with  partial  hysterical  pa- 
ralysis of  the  right  and  hemi-ansesthesia  of  the 
left  side.  She  had  no  power  to  feel  pain  or  to 
distinguish  heat  from  cold  in  the  left  leg  and 
arm,  though  the  sense  of  touch  was  perfect.  The 
long  strain  of  great  mental  suiFering  had  left 
her  in  this  state  and  rendered  her  somewhat 
emotional.  Her  appetite  was  fair,  but  she  was 
strangely  white,  and  weighed  one  hundred  and 
sixty-three  pounds,  with  a  height  of  five  feet  five 
inches.  As  she  had  had  endless  treatment  by 
iron,  change  of  air,  and  the  like,  I  did  not  care 
to  repeat  what  had  already  failed.  She  was 
therefore  put  at  rest,  and  treated  with  milk, 
slowly  lessened  in  amount.  Her  stomach-trou- 
bles, which  had  been  very  annoying,  disappeared, 
and  when  the  milk  fell  to  three  pints  she  began 
to  lose  flesh.  With  a  quart  of  milk  a  day  she 
lost  half  a  pound  daily,  and  in  two  weeks  her 
weight  fell  to  one  hundred  and  forty  pounds. 
She  was  then  placed  on  the  full  treatment  which 
I  shall  hereafter  describe.  The  weight  returned 
slowly,  and  with  it  she  became  quite  ruddy,  while 
her  flesh  lost  altogether  its  flabby  character.  I 
never  saw  a  more  striking  result. 


DIETETICS  AND    THERAPEUTICS.  m 

I  have  been  careful  to  speak  at  length  of  these 
fat  anaemic  cases,  because,  while  rare,  they  have 
been,  to  me  at  least,  among  the  most  difficult  to 
manage  of  all  the  curable  anaemias,  and  because 
with  the  plan  described  I  have  been  almost  as 
successful  as  I  could  desire. 

Let  us  now  suppose  that  we  have  to  deal  with 
a  person  of  another  and  different  type, — one  of 
the  larger  class  of  feeble,  thin-blooded,  neuras- 
thenic or  hysterical  women.  Let  us  presume 
that  every  ordinary  and  easily  attainable  means 
of  relief  has  been  utterly  exhausted,  for  not 
otherwise  do  I  consider  it  reasonable  to  use  so 
extreme  a  treatment  as  the  one  w^e  are  now  to 
consider.  Inevitably,  if  it  be  a  woman  long  ill 
and  long  treated,  we  shall  have  to  settle  the 
question  of  uterine  therapeutics.  A  careful  ex- 
amination is  made,  and  we  learn  that  there  is 
decided  displacement.  In  this  case  it  is  well  to 
correct  it  at  once  and  to  let  the  uterine  treatment 
go  on  with  the  general  treatment.  If  there  be 
bad  lacerations  of  the  womb  or  perineum,  their 
surgical  relief  may  await  a  change  in  the  general 
status  of  health, — say  at  the  fourth  or  fifth  week. 
If  there  be  only  congestive  or  other  morbid 
states  of  the  womb  or  ovaries,  they  are  best  left 


112  DIETETICS  AND    THERAPEUTICS. 

to  be  aided  by  the  general  gain  in  health ;  but 
in  this  as  in  every  other  stage  of  this  treatment  it 
is  unwise,  and  undesirable  therefore,  to  lay  down 
too  absolute  laws.  Having  satisfied  ourselves  as 
to  these  points,  and  that  rest,  etc.,  is  needful,  we 
begin  treatment,  if  possible,  at  the  close  of  a 
menstrual  period,  because  usually  the  monthly 
flow  is  a  time  at  which  there  is  little  or  no  gain, 
and  by  starting  our  treatment  when  it  is  just 
over  we  save  a  week  of  time  in  bed. 

The  next  step  is,  usually,  to  get  her  by  degrees 
on  a  milk  diet,  which  has  two  advantages.  It 
enables  us  to  know  precisely  the  amount  of  food 
taken,  and  to  regulate  it  easily;  and  it  nearly 
always  dismisses,  as  by  magic,  all  the  dyspeptic 
conditions.  If  the  case  be  an  old  one,  I  rarely 
omit  the  milk ;  but,  although  I  begin  with  three 
or  four  ounces  every  two  hours,  I  increase  it 
in  a  few  days  up  to  two  quarts,  given  in  di- 
vided doses  every  three  hours.  If  a  cup  of 
coff'ee  given  without  sugar  on  awaking  does  not 
regulate  the  bowels,  I  add  a  small  amount  of 
watery  extract  of  aloes  at  bedtime;  or  if  the 
constipation  be  obstinate,  I  give  thrice  a  day 
one-quarter  of  a  grain  of  watery  extract  of  aloes 
with   two  grains  of  dried   ox-gall.     I  find  the 


DIETETICS  AND    THERAPEUTICS.  113 

simple  milk  diet  a  great  aid  towards  getting  rid 
of  chloral,  bromides,  and  morphia,  all  of  which 
I  usually  am  able  to  lay  aside  during  the  first 
week  of  treatment.^  ITor  is  it  less  easy  with  the 
same  means  to  enable  the  patient  to  give  up 
stimulus ;  and  I  may  add  that  in  the  treatment 
of  the  congested  stomach  of  the  habitual  hard 
drinker  the  milk  treatment  is  of  admirable  effi- 
cacy. As  I  have  spoken  over  and  over  of  the 
use  of  stimulus  by  nervous  women,  I  should 
be  careful  to  explain  that  anything  like  great  ex- 
cess on  the  part  of  women  of  the  upper  classes, 
in  this  country  at  least,  is,  in  my  opinion, 
extremely  rare,  and  that  when  I  speak  of  the 
habit  of  stimulation  I  mean  only  that  nervous 
women  are  apt  to  be  taught  to  take  wine  or 
whiskey  daily,  to  an  extent  that  does  not  afiect 
visibly  their  appearance  or  demeanor. 

1  The  management  of  the  morphia  or  chloral  habit  be- 
comes much  more  easy  under  a  milk  diet,  massage,  and  abso- 
lute rest,  and  I  can  with  confidence  commend  their  use  in 
these  diflScult  cases.  Massage  in  the  morning  is  liked,  and 
general  surface-rubbing  without  muscle-kneading  at  night 
very  often  proves  remarkably  soothing,  while  the  rest  in  bed 
cuts  off  many  opportunities  to  indulge  in  the  temptation  to 

secure  the  desired  drugs. 

h  10* 


114  DIETETICS  AND    THERAPEUTICS. 

Meanwhile,  the  mechanical  treatment  is  stead- 
ily pursued,  and  within  four  days  to  a  week, 
when  the  stomach  has  become  comfortable,  I 
order  the  patient  to  take  also  a  light  breakfast. 
A  day  or  two  later  she  is  given  a  mutton-chop 
as  a  mid-day  dinner,  and  again  in  a  day  or  two 
she  has  added  bread-and-butter  thrice  a  day ; 
within  ten  daj^s  I  am  commonly  able  to  allow 
three  full  meals  daily,  as  well  as  three  or  four 
pints  of  milk,  which  are  given  at  or  after  meals, 
in  place  of  water. 

After  ten  days  I  order  also  two  to  four  ounces 
of  fluid  malt  extract  before  each  meal.  The 
fluid  malt  extracts  which  now  reach  us  from 
Germany  have  become  less  trustworthy  than 
they  formerly  were.  Some  of  them  keep  badjy, 
and  are  uncertain  in  composition,  one  Dottle 
being  good,  another  bad.  Of  the  English  ex- 
tracts I  know  but  little.  The  more  constant, 
and  at  the  same  time  the  most  agreeable,  extracts 
are  those  now  made  in  this  country.  They  have 
not  as  yet  been  subjected  to  examination  by  un- 
interested chemists,  and  may  not  prove  on  analy- 
sis to  be  all  that  is  required,  but  so  far  have 
seemed  to  me  on  the  whole  more  satisfactory 
than  the  imported  malts.   It  is  very  desirable  that 


DIETETICS  AND    THERAPEUTICS.  115 

a  thorough  chemical  study  should  be  made  of  the 
various  malt  extracts,  solid  and  liquid.  I  am 
sure  that  some  of  them  are  defective  in  compo- 
sition, or  vary  notably  as  to  the  amount  of  alco- 
hol they  contain. 

'^o  troublesome  symptoms  usually  result  from 
this  full  feeding,  and  the  patient  may  be  made  to 
eat  more  largely  by  being  fed  by  her  attendant. 
People  who  will  eat  very  little  if  they  feed  them- 
selves, often  take  a  large  amount  when  fed  by 
another ;  and,  as  I  have  said  before,  nothing  is 
more  tiresome  than  for  a  patient  flat  on  her  back 
to  cut  up  her  food  and  to  use  the  fork  or  spoon. 
By  the  plan  of  feeding  we  thus  gain  doubly. 

As  to  the  meals,  I  leave  them  to  the  patient's 
caprice,  unless  this  is  too  unreasonable ;  but  I  like 
to  give  butter  largely,  and  have  little  trouble  in 
getting  this  most  wholesome  of  fats  taken  in 
large  amounts.  A  cup  of  cocoa  or  of  coffee 
wdth  milk  on  waking  in  the  morning  is  a  good 
preparation  for  the  fatigue  of  the  toilet. 

At  the  close  of  the  first  w^eek  I  like  to  add  one 
pound  of  beef,  in  the  form  of  raw  soup.  This 
is  made  by  chopping  up  one  pound  of  raw  beef 
and  placing  it  in  a  bottle  with  one  pint  of  water 
and  ^YQ  drops  of  strong  hydrochloric  acid.    This 


116  DIETETICS  AND   THERAPEUTICS. 

mixture  stands  on  ice  all  night,  and  in  the  morn- 
ing the  bottle  is  set  in  a  pan  of  water  at  110°  F, 
and  kept  two  hours  at  about  this  temperature. 
It  is  then  thrown  on  to  a  stout  cloth  and  strained 
until  the  mass  which  remains  is  nearly  dry. 
The  filtrate  is  given  in  three  portions  daily.  If 
the  raw  taste  prove  very  objectionable,  the  beef 
to  be  used  is  quickly  roasted  on  one  side,  and 
then  the  process  is  completed  in  the  manner 
above  described.  The  soup  thus  made  is  for  the 
most  part  raw,  but  has  also  the  flavor  of  cooked 
meat. 

In  difficult  cases,  especially  those  treated  in 
cool  weather,  I  sometimes  add,  at  the  third  week, 
one  half-ounce  of  cod-liver  oil,  given  half  an 
hour  after  each  meal.  If  it  lessen  the  appetite, 
or  cause  nausea,  I  employ  it  thrice  a  day  as  a 
rectal  injection ;  and  in  cases  where  the  large 
doses  of  iron  used  cause  intense  constipation,  I 
find  the  use  of  cod-oil  enemata  doubly  valuable, 
by  acting  as  a  nutriment  and  by  disposing  the 
bowels  to  act  daily.  When  given  thus,  I  like  to 
use  it  in  an  emulsion  made  with  the  juice  drained 
oflf  after  crushing  the  fresh  pancreas  of  the  beef 
in  warm  water.  Enough  of  water  to  cover  a  half- 
pound  of  chopped  pancreas  is  allowed  to  stand 


DIETETICS  AND    THERAPEUTICS,  117 

for  an  hour  in  a  warm  kitchen,  and  then  squeezed 
through  a  towel.  An  ounce  is  mixed  with  half 
that  amount  of  oil  and  injected  slowly  thrice  a 
day,  or  the  pancreatic  emulsions  of  commerce 
may  be  used  with  the  oil.  These  preparations 
suit  some  people  well,  and  may  result  in  a  single 
passage  daily,  but  in  others  they  are  annoying, 
and  are  either  badly  retained  or  not  retained  at 
all,  and  sometimes  give  rise  to  tenesmus. 

The  question  of  stimulus  is  a  grave  one.     In 
too  many  cases  which  come  to  me,  I  have  to 
give  so  much  care  to  break  off  the  use  of  all 
forms  of  alcoholic  drinks  that  I  am  loath  to  re- 
sort to  them  in  any  case,  although  I  am  satis- 
fied that  a  small  amount  is  a  help  towards  speedy 
increase  of  fat.    Its  use  is,  therefore,  a  matter  for 
careful  judgment,  and  in  persons  who  have  never 
taken   it  in  excess,  or  as  a  habit,  I  prefer  to 
give,  with  the   other   treatment,  a   small  daily 
ration  of  stimulus  :  an  ounce  a  day  of  whiskey  in 
milk,  or  a  glass  of  dry  champagne  or  red  wine, 
seems  to  me  useful  as  an  adjuvant,  and  as  increas- 
ing the  capacity  to  take  food  at  meals.     Never- 
theless, alcohol  is  not  essential,  and  for  the  most 
part  I  give  none,  except  the  small  amount — some 
four  per  cent. — present  in  fluid  malt   extracts. 


118  DIETETICS  AND    THERAPEUTICS. 

Even  this  is  found  to  excite  certain  persons,  and 
it  is  in  such  cases  easy  to  substitute  the  thicker 
extracts  of  malt,  or  the  Japanese  extract,  made 
from  barley  and  rice. 

So  soon  as  my  patient  begins  to  take  other 
food  than  milk,  and  sometimes  even  before 
this,  I  like  to  give  iron  in  large  doses.  In 
hospital  practice  the  old  subcarbonate  answers 
very  v^^ell,  being  cheap,  and  not  unpalatable 
when  shaken  up  in  water  or  given  in  an  effer- 
vescent draught  of  carbonated  waters.  In  pri- 
vate practice  large  doses  of  salts  of  iron,  as  four 
to  six  grains  of  lactate  at  meal -time,  are  satisfac- 
tory ;  but  the  form  of  iron  is  of  less  moment  than 
the  amount. 

Very  often  I  meet  with  women  who  cannot 
take  iron,  either  because  it  disturbs  the  stomach, 
causes  headache,  or  constipates,  or  else  because 
they  have  been  told  never  to  take  iron.  In  the 
latter  case  I  simply  add  five  grains  of  the  pyro- 
phosphate to  each  ounce  of  malt,  and  give  it  thus 
for  a  month  unknown  to  the  patients.  It  is  then 
easy  to  make  clear  to  them  that  iron  is  not  so 
difficult  to  take  as  they  had  been  led  to  believe, 
and  when  it  has  ceased  to  disagree  mentally  I 
find  that  I  am  able  to  fall  back  on  the  coarser 


DIETETICS  AND    THERAPEUTICS.  119 

method.  If  iroD  constipate,  as  it  may  and  does 
often  do  when  used  in  these  large  doses,  the 
trouble  is  to  be  corrected  by  fruit,  and  especially 
pears,  by  the  pill  of  the  watery  extract  of  aloes 
and  ox-gall  already  mentioned,  by  extracts  of 
cascara  or  of  juglans  cinerea,  or  by  the  enemata 
of  oil.  The  instances  in  which  iron  gives  head- 
ache and  sense  of  fulness  are  very  rare  when 
the  patient  is  undergoing  the  full  treatment 
described,  and,  as  a  rule,  I  disregard  all  such 
complaints,  and  find  that  after  a  time  I  cease 
to  hear  anything  more  of  these  symptoms. 

Unless  some  especial  need  arises,  iron,  in 
some  form,  is  the  only  drug  I  care  to  use  until 
the  patient  begins  to  sit  up,  when  I  order  nearly 
always  sulphate  of  str^^chnia,  in  rather  full  doses, 
thrice  a  day,  with  iron  and  arsenic. 

Probably  no  physician  will  read  the  account  I 
have  here  detailed  of  the  vast  amount  of  food 
which  I  am  enabled  to  give,  not  only  with  im- 
punity from  dyspepsia,  but  with  lasting  advan- 
tage, without  some  sense  of  wonder ;  and,  for  my 
own  part,  I  can  only  say  that  I  have  watched 
again  and  again  with  growing  surprise  some 
listless,  feeble,  white-blooded  creature  learning 
by  degrees  to  consume  these  large  rations,  and 


120  DIETETICS  AND    THERAPEUTICS. 

gathering  under  their  use  flesh,  color,  and  whole- 
sorneness  of  mind  and  body.  It  is  needless  to 
say  that  it  is  not  in  all  cases  easy  to  carry  out 
this  treatment. 

When  the  full  treatment  has  been  reached, 
and  kept  up  for  a  few  days,  I  begin  to  watch  the 
urine  with  care,  because  if  the  patient  be  over- 
fed the  renal  secretion  speedily  betrays  this  re- 
sult in  the  precipitation  of  urates.  When  this 
occurs  at  all  steadily,  I  usually  give  directions 
to  lessen  the  amount  of  food  until  the  urine  is 
again  free  from  sediment. 

Nearly  always  at  some  time  in  the  progress  of 
the  case  there  are  attacks  of  dyspepsia,  when  it 
suffices  to  cut  down  the  diet  one- half,  or  to  give 
mi-Ik  alone  for  a  day  or  two.  Diarrhoea  is  more 
rare,  and  has  to  be  met  in  like  manner;  or,  if 
obstinate,  it  may  be  requisite  to  give  the  milk 
boiled.  Occasionally  the  rapid  increase  of  blood 
is  shown  by  nasal  hemorrhage,  which  needs  no 
especial  treatment. 

Perhaps  I  shall  make  myself  more  clear  if  I 
now  relate  in  full  the  diet-list  of  some  of  my 
cases,  and  the  mode  of  arranging  it. 

I  take  the  following  case  as  an  illustration 
from  my  note-book  : 


DIETETICS  AND    THERAPEUTiCS.  121 

Mrs.  C,  a  ITew  England  woman,  set.  33,  under- 
took, at  the  age  of  sixteen,  a  severe  course  of 
mental  labor,  and  within  two  years  completed 
the  whole  range  of  studies  which,  at  the  school 
she  went  to,  were  usually  spread  over  four  years. 
An  early  marriage,  three  pregnancies,  the  last 
two  of  which  broke  in  upon  the  years  of  nursing, 
began  at  last  to  show  in  loss  of  flesh  and  color. 
Meanwhile,  she  met  with  energy  the  multiplied 
claims  of  a  life  full  of  sympathy  for  every  form 
of  trouble,  and,  neglecting  none  of  the  duties 
of  society  or  kinship,  yet  found  time  for  study 
and  accomplishments.  By  and  by  sh«  began  to 
feel  tired,  and  at  last  gave  way  quite  abruptly, 
ceased  to  menstruate  five  years  before  I  saw  her, 
grew  pale  and  feeble,  and  dropped  in  weight  in 
six  months  from  one  hundred  and  twenty-five 
pounds  to  ninety-five.  ligature  had  at  last  its 
revenge.  Everything  wearied  her, — to  eat,  to 
drive,  to  read,  to  sew.  Walking  became  impos- 
sible, and,  tied  to  her  couch,  she  grew  dyspeptic 
and  constipated.  The  asthenopia  which  is  al- 
most constantly  seen  in  such  cases  added  to  her 
trials,  because  reading  had  to  be  abandoned,  and 
so  at  last,  despite  unusual  vigor  of  character,  she 
gave  way  to  utter  despair,  and  became  at  times 
p  11 


122  DIETETICS  AND    THERAPEUTICS. 

emotional  and  morbid  in  her  views  of  life.  After 
numberless  forms  of  treatment  had  been  used 
in  vain,  she  came  to  this  city  and  passed  into  my 
care. 

At  this  time  she  could  not  walk  more  than  a 
few  steps  without  flushing  and  without  a  sense 
of  painful  tire.  Her  morning  temperature  was 
97.5°  F.,  and  her  white  corpuscles  were  perhaps 
a  third  too  numerous.  After  most  careful  exam- 
ination, I  could  find  no  disease  of  any  one  organ, 
and  I  therefore  advised  a  resort  to  the  treatment 
by  rest,  with  full  confidence  in  the  result. 

In  this  single  case  I  give  the  schedule  of  diet 
in  full  as  a  fair  example  : 

Mrs.  C.  remained  in  bed  in  entire  repose.  She 
was  fed,  and  rose  only  for  the  purpose  of  re- 
lieving the  bladder  or  the  rectum. 

October  10. — Took  one  quart  of  milk  in  di- 
vided doses  every  two  hours. 

11th. — A  cup  of  coflfee  on  rising,  and  two 
quarts  of  milk  given  in  divided  portions  every 
two  hours.  A  pill  of  aloes  every  night,  which 
answered  for  a  few  days. 

12th  to  15th. — Same  diet.  The  dyspepsia  by 
this  time  was  relieved,  and  she  slept  without  her 
habitual  dose  of  chloral.  The  pint  of  raw  soup 
was  added  in  three  portions  on  the  16th. 


DIETETICS  AND    THERAPEUTICS.  123 

ITth  and  18tli. — Same  diet. 

19th. — She  took,  on  awaking  at  7,  coffee ;  at 
7.30,  a  half-pint  of  milk ;  and  the  same  at  10 
A.M.,  12  M.,  2,  4,  6,  8,  and  10  p.m.  The  soup  at 
11,  5,  and  9. 

23d. — She  took  for  breakfast  an  Qgg  and  bread- 
and-butter  ;  and  two  days  later  {25th)  dinner  was 
added,  and  also  iron. 

On  the  28th  this  was  the  schedule : 

On  waking,  coffee  at  7.  At  8,  iron  and  malt. 
Breakfast,  a  chop,  bread-and-butter ;  of  milk,  a 
tumbler  and  a  half.  At  11,  soup.  At  2,  iron 
and  malt.  Dinner,  closing  with  milk,  one  or 
two  tumblers.  The  dinner  consisted  of  anything 
she  liked,  and  with  it  she  took  about  six  ounces 
of  burgundy  or  dry  champagne.  At  4,  soup.  At 
7,  malt,  iron,  bread-and-butter,  and  usually  some 
fruit,  and  commonly  two  glasses  of  milk.  At  9, 
soup;  and  at  10  her  aloe  pill.  At  12  m.,  mas- 
sage occupied  an  hour.  At  4.30  p.m.,  electricity 
was  used  for  an  hour  in  the  manner  which  I 
have  described. 

This  heavy  diet-list,  reached  in  a  few  days  by 
a  woman  who  had  been  unable  to  digest  with 
comfort  the  lightest  meal,  seemed  certainly  sur- 
prising.    I  have  not  given  in  full  the  amount  of 


124  DIETETICS  AND    THERAPEUTICS. 

food  eaten  at  meal-time.  Small  at  first,  it  was 
increased  rapidly  owing  to  the  patient's  growing 
appetite,  and  became  in  a  few  davs  three  large 
meals. 

It  is  necessary  to  see  the  result  in  one  of  these 
successful  cases  in  order  to  credit  it.  Mrs.  C. 
began  to  show  gain  in  flesh  about  the  face  in  the 
second  week  of  treatment,  and  during  her  two 
months  in  bed  rose  in  weight  from  ninety-six 
pounds  to  one  hundred  and  thirty-six ;  nor  was 
the  gain  in  color  less  marked. 

At  the  sixth  week  of  treatment  the  soup  waa 
dropped,  wine  abandoned,  the  iron  lessened  one- 
half,  the  massage  and  electricity  used  on  alter- 
nate days,  and  the  limbs  exercised  as  I  have  de- 
scribed. The  usual  precautions  as  to  rising  and 
exercise  were  carefully  attended  to,  and  at  the 
ninth  week  of  treatment  my  patient  took  a  drive. 
At  this  time  all  mechanical  treatment  ceased, 
the  milk  was  reduced  to  a  quart,  the  iron  to  five 
grains  thrice  a  day,  and  the  malt  continued.  At 
the  sixth  week  I  began  to  employ  strychnia  in 
doses  of  one-thirtieth  of  a  grain  thrice  a  day  at 
meals,  and  this  was  kept  up  for  several  months, 
tosrether  with  the  iron  and  malt.  The  cure  was 
complete  and  permanent;  and  its  character  may 


DIETETICS  AND    THERAPEUTICS.  125 

be  tested  by  tbe  fact  that  at  the  thirtieth  day  of 
rest  in  bed,  and  after  five  years  of  failure  to 
menstruate,  to  her  surprise  she  had  a  normal 
monthly  flow.  This  continued  with  regularity 
until  eighteen  months  later,  when  she  became 
pregnant.  The  only  drawback  to  her  perfect 
use  of  all  her  functions  lay  in  asthenopia,  which 
lasted  nearly  a  year  after  she  left  my  care.  Fa- 
tigue of  vision  for  near  work  is  a  common  con- 
dition of  the  cases  I  am  now  describing,  and  is 
apt  to  persist  long  after  all  other  troubles  have 
vanished.  When  there  is  no  asthenopia  I  usually 
think  well  of  the  general  chance  of  recovery ;  but 
in  no  case  of  feeble  vision  do  I  omit  at  some 
period  of  the  treatment  to  have  the  optical  appa- 
ratus of  the  eye  looked  at  with  care,  because  pure 
asthenopia,  apart  from  all  optical  defects,  is  a 
somewhat  rare  symptom. 

E^either  am  I  always  satisfied  with  the  ophthal- 
mologist's dictum  that  there  is  a  defect  so  slight 
as  to  need  no  correction,  being  well  aw^are,  as  I 
have  elsewhere  pointed  out,  that  even  minute 
^  ocular  defects  are  competent  mischief-makers 
w^hen  the  brain  becomes  what  I  may  permit  my- 
self, using  the  photographer's  language,  to  call 

sensitized  by  disease. 

11* 


126  DIETETICS  AND   THERAPEUTICS. 

The  followino^  illustrations  of  success  in  this 
mode  of  treatment  are  taken  from  Dr.  Play  fair's 
book '} 

"  Early  in  October  of  last  year  I  was  asked  to 
see  a  lady  thirty-two  years  of  age,  with  the  fol- 
lowing history.  She  had  been  married  at  the 
age  of  twenty-two,  and  since  the  birth  of  her 
last  child  had  suffered  much  from  various  uterine 
troubles,  described  to  me  by  her  medical  attend- 
ant as  '  ulceration,  perimetritis,  and  endome- 
tritis.' Shortly  after  the  death  of  her  husband, 
in  1876,  these  culminated  in  a  pelvic  abscess, 
which  opened  first  through  the  bladder  and 
afterwards  through  the  vagina.  Paralysis  of  the 
bladder  immediately  followed  the  appearance  of 
pus  in  the  urine,  and  from  that  time  the  urine 
was  never  spontaneously  voided,  and  the  cathe- 
ter was  always  used.  Soon  after  this  she  began 
to  lose  power  in  the  right  leg,  and  then  in  the 
left,  until  they  both  became  completely  para- 
lyzed, so  that  she  could  not  even  move  her  toes, 
and  lay  on  her  back  with  her  legs  slightly  drawn 
up,  the  muscles  being  much  wasted.  Towards 
the  end  of  1877,  after  some  pain  in  the  back 

^  Nerve  Prostration  and  Hysteria. 


DIETETICS  AND   THERAPEUTICS.  127 

of  her  neck  and  twitching  of  the  muscles,  she 
hegan  to  lose  power  in  her  left  arm  and  in  her 
neck,  so  that  she  lay  absolutely  immobile  in  bed, 
the  only  part  of  her  body  she  was  able  to  move 
at  all  being  her  right  arm.  Up  to  this  time  the 
pelvic  abscess  had  continued  to  discharge  through 
the  vagina,  and  occasionally  through  the  blad- 
der, but  it  now  ceased  to  do  so,  and  there  were 
no  further  symptoms  referable  to  the  uterine 
organs.  Her  general  condition,  however,  re- 
mained unaltered,  in  spite  of  the  most  judicious 
medical  treatment.  She  was  seen,  from  time  to 
time,  by  several  of  our  most  eminent  consult- 
ants, all  of  whom  recognized  the  probable  hys- 
terical character  of  her  illness,  but  none  of  the 
remedies  employed  had  any  beneficial  effect. 
There  was  almost  total  anorexia,  the  amount 
of  food  consumed  was  absurdly  small,  and  the 
necessary  consequence  of  this  inability  to  take 
food,  combined  with  four  years  in  bed  with 
paralysis  of  the  greater  part  of  the  body,  and 
the  habitual  use  of  chloral  to  induce  sleep, 
had  reduced  a  naturally  fine  woman  to  a 
mere  shadow.  In  October,  1880,  her  medical 
attendant  was  good  enough  to  bring  her  to 
London  for  the  purpose  of  giving  a  fair  trial 


128  DIETETICS  AND    THERAPEUTICS. 

to  the  Weir  Mitchell  method  of  treatment, 
with  the  ready  co-operation  of  herself  and  her 
friends,  and  she  was  conveyed  on  a  couch  slung 
from  the  roof  of  a  saloon  carriage,  so  as  to  avoid 
any  jolt  or  jar,  since  the  slightest  movement 
caused  much  suffering.  Two  days  after  her 
arrival  my  friend  Dr.  Buzzard  saw  her  with  me, 
and,  after  a  careful  and  prolonged  electrical  ex- 
amination, came  to  the  conclusion  that  contrac- 
tility existed  in  all  the  affected  muscles,  and  that 
the  paralysis  was  purely  functional.  I  could 
find  no  evidence  in  the  pelvis  of  the  abscess,  the 
uterus  being  perfectly  mobile,  and  apparently 
health}^  After  a  few  days'  rest  the  treatment 
was  commenced  on  October  16,  the  patient  being 
isolated  in  lodgings  with  a  nurse  of  my  own 
choosing ;  and  this  was  the  only  difficulty  I  had 
with  her,  since  she  naturally  felt  acutely  the 
separation  from  the  faithful  attendant  who  had 
nursed  her  during  her  long  illness.  Her  friends 
agreed  not  to  have  communication  with  her  of 
any  sort.  It  is  needless  to  give  the  details  of 
the  treatment  in  this  and  the  following  cases. 
A  mere  abstract  will  suffice  to  indicate  the  rapid 
and  satisfactory  progress  made. 

"  October  16. — Twenty-two  ounces  of  milk  were 


DIETETICS  AND    THERAPEUTICS.  129 

taken,  in  divided  doses,  in  twenty-four  hours ;  on 
the  17th,  fifty  ounces  of  milk;  on  the  18th,  the 
same  quantity  of  milk  repeated ;  massage  for 
half  an  hour;  on  the  19th,  milk  as  before; 
bread-and-butter  and  Qgg]  massage  for  an  hour 
and  a  half;  twenty  minims  of  dialyzed  iron  twice 
daily ;  on  the  21st,  a  mutton-chop  in  addition  to 
the  above ;  massage  an  hour  and  fifty  minutes. 
To-day  she  passed  water  for  the  first  time  for 
four  years,  and  the  catheter  was  never  again 
used.  Chloral  discontinued,  and  she  slept  natu- 
rally all  night  long.  On  the  23d,  porridge  and  a 
gill  of  cream  were  added  to  her  former  diet ;  mas- 
sage three  hours  daily,  and  electricity  for  half  an 
hour,  and  this  was  continued  until  the  end  of  the 
treatment.     Mai  tine  was  now  given  twice  daily. 

"  October  30. — She  is  now  consuming  three  full 
meals  daily  of  fish,  meat,  vegetables,  cream,  and 
fruit,  besides  two  quarts  of  milk  and  two  glasses 
of  burgundy.  Considerable  muscular  powder  is 
returning  in  her  limbs,  which  she  can  now  move 
freely  in  bed. 

"  November  6. — Sat  in  a  chair  for  an  hour. 
The  massage  and  electricity  are  being  gradually 
discontinued,  and  the  amount  of  food  lessened. 

"  November  17. — Walked  down-stairs,  and  went 


130  DIETETICS  AND    THERAPEUTICS. 

out  for  a  drive,  and  henceforth  she  went  out  daily 
in  a  Bath-chair.  She  has  increased  enormously 
in  size,  and  looks  an  entirely  different  person 
from  the  wasted  invalid  of  a  few  weeks  as^o. 

"  On  I^ovember  26  she  went  to  Brighton  quite 
convalescent,  and  on  December  11  came  up  of 
her  own  accord  to  see  me,  drove  in  a  hansom  to 
my  house,  and  returned  the  same  afternoon.  She 
has  since  remained  perfectly  strong  and  well,  and 
has  resumed  the  duties  of  life  and  society. 

"A  somewhat  curious  phenomenon  in  this  case, 
which  I  am  unable  to  account  for,  was  the  for- 
mation on  the  anterior  surface  of  the  legs,  ex- 
tending from  below  the  patellae  half-way  down 
the  tibiae,  of  two  large  sacs  of  thin  fluid,  con- 
taining, I  should  say,  each  a  pint  or  more,  freely 
fluctuating,  and  quite  painless-.  I  left  them  alone, 
and  they  have  spontaneously  disappeared." 

"  In  May,  1880, 1  saw  with  Dr.  Julius,  of  Hast- 
ings, an  unmarried  lady,  aged  thirty-one.  Her 
history  was  that  she  had  been  in  fairly  good 
health  until  five  years  ago,  when,  during  her 
mother's  illness,  she  overtaxed  her  strength  in 
nursing,  since  which  time  she  has  been  a  con- 
stant invalid,  suffering  from  backache,  bearing 
down,  inability  to  walk,  disordered  menstruation, 


DIETETICS  AND    THERAPEUTICS.  131 

and  the  usual  train  of  uterine  symptoms.     She 
used  to  get  a  little  better  on  going  to  the  sea-side, 
but  soon  became  ill  again,  and  in  October,  1879, 
she  was  completely  laid  up.     The  least  standing 
or  walking  brought  on  severe  pain  in  her  back 
and  side,  and  she  gave  up  the  attempt,  and  had 
since  remained  entirely  confined  to  her  bed  or 
sofa,  suffering  from  constant  nausea,  complete 
loss  of  appetite,  and  depending  on  chloral  and 
morphia  for  relief.     Many  efforts  had  been  made 
to  break  her  of  this  habit,  but  in  vain.     Her 
medical  attendant  had  recognized  the  existence 
of  a  retroflexion,  but  no  pessary  remained  in  situ 
for  more  than  a  day  or  so,  and  he  suspected  that 
she  herself  pulled  them  out.     I  was  unable  to  do 
more  than  confirm  the  diagnosis  that  had  been 
made  as  to  her  local  condition,  but  the  pessary  I 
introduced  shared  the  fate  of  its  predecessors, 
and  she  remained  in  the  same  condition, — in  no 
way  benefited   by  my  visit.     Things  going  on 
from  bad  to  worse.  Dr.  Julius  sent  her  to  London 
for  treatment  in  the  early  part  of  December.     I 
now  determined  to  try  the  effect  of  the  method  I 
am  discussing,  of  which  I  knew  nothing  when  I 
first  saw  her.     It  was  commenced  on  December 
11,  and  everything  went  on  most  favorably.     A 


132  DIETETICS  AND    THERAPEUTICS. 

week  after  it  was  begun,  when  her  attention  wa? 
fully  occupied  with  the  diet,  massage,  etc.,  I  in- 
troduced a  stem  pessary,  being  tempted  to  try 
this  instrument,  which  I  rarely  use,  by  the 
knowledge  that  she  was  at  perfect  rest,  and  that 
no  form  of  Hodge  had  previously  been  retained. 
I  do  not  think  she  ever  knew  she  had  it,  and  it 
remained  in  situ  for  a  month,  when  I  removed 
it  and  inserted  a  Hodge,  which  was  thenceforth 
kept  in  without  any  trouble.  I  may  say  that 
I  do  not  think  the  retroflexion  had  much  to 
do  with  her  symptoms,  except,  doubtless,  at  the 
commencement  of  her  illness,  and  she  probably 
would  have  done  quite  as  well  without  any  local 
treatment.  She  rapidly  gained  flesh  and  strength, 
and  very  soon  I  entirely  stopped  both  chloral  and 
morphia,  and  she  never  seemed  to  miss  them. 
On  December  11,  when  the  treatment  was  com- 
menced, she  weighed  5  st.  9  lbs.  On  January  20 
she  weighed  7  st.  On  January  25  she  walked 
down-stairs,  and  went  out  for  a  drive,  and  from 
that  time  she  went  out  twice  daily.  She  com- 
plained of  no  pain  of  any  kind,  and,  although 
she  wore  a  Hodge,  she  did  not  seem  to  have  any 
uterine  symptoms.  On  February  1  she  went  to 
the  sea-side,  looking  rosy,  fat,  and  he^althj^,  and 


DIETETICS  AND    THERAPEUTICS.  133 

has  since  returned  to  her  home  in  the  country, 
where  she  remains  perfectly  strong  and  well.  A 
few  days  ago  she  came  to  town,  a  long  railway 
journey,  on  purpose  to  announce  to  me  her  ap- 
proaching marriage." 

"  On  September  10  a  gentleman  came  to  con- 
sult me  on  the  case  of  his  wife,  in  consequence 
of  his  attention  having  been  directed  to  my 
former  papers  by  a  relative  who  is  a  well-know^n 
physician  in  London.  He  informed  me  that  his 
wife  was  now  fifty-five  years  of  age,  and  that  she 
had  passed  ten  years  of  her  married  life  in  India. 
At  the  age  of  thirty  she  was  much  weakened  by 
several  successive  miscarriages,  and  then  drifted 
into  confirmed  ill  health.  He  wrote,  on  making 
an  appointment,  as  follows  :  *  I  will  give  you  at 
once  a  short  outline  of  her  case.  We  have  been 
married  thirty-four  years,  of  which  the  last 
twenty  have  been  spent  by  her  in  bed  or  on  the 
sofa.  She  is  unable  even  to  stand,  and  finds 
the  pain  in  her  back  too  great  to  admit  of  her 
sitting  up.  She  is  utterly  without  strength,  of 
an  intensely  nervous  temperament,  and  suffers 
incessantly  from  neuralgia.  She  has,  moreover, 
an  outward  curvature  of  the  spine.  There  ir.  not 
the  slightest  symptom  of  paralysis.    Fortunately. 

12 


134  DIETETICS  AND    THERAPEUTICS. 

she  does  not  touch  morphia,  or  any  narcotic  or 
stimulant,  beyond  a  glass  or  two  of  wine  in  the 
day.  That  she  has  long  been  in  a  state  of  hys- 
teria is  the  opinion  of  nearly  all  the  many  medi- 
cal men  \vho  have  seen  her.' 

*^  Although  the  attempt  to  cure  so  aggravated 
a  case  as  this  was  certainly  a  sufficiently  severe 
test  of  the  treatment,  I  determined  to  make  the 
trial,  and  had  the  patient  removed  from  her  own 
home  and  isolated  in  lodgings.  I  found  her  in 
bed,  supported  everywhere  by  many  small  pil- 
lows, and  wasted  more  than,  I  think,  I  had  ever 
seen  any  human  being.  She  really  hardly  had 
any  covering  to  her  bones,  and  looked  somewhat 
like  the  picture  of  the  living  skeleton  we  are 
familiar  with.  It  may  give  some  idea  of  her 
emaciation  if  I  state  that,  though  naturally  not  a 
small  woman,  her  height  being  five  feet  ^yq 
and  a  half  inches,  she  weighed  only  4  st.  7  lbs., 
and  I  could  easily  make  my  thumb  and  fore- 
finger meet  round  the  thickest  part  of  the  calf 
of  her  leg.  The  curvature  of  the  spine  said  to 
exist  was  a  deceptive  appearance,  produced  by 
her  excessive  leanness,  and  the  consequent  un- 
natural prominence  of  the  spinous  processes  of 
the  vertebrre.     I  could  detect  no  orsranic  disease 


DIETETICS  AND    THERAPEUTICS.  I35 

of  any  kind.  The  appetite  was  entirely  wanting, 
and  she  consumed  hardly  any  food  beyond  a  little 
milk,  a  few  moiitlafuls  of  bread,  and  the  like. 
From  the  first  the  patient's  improvement  was 
steady  and  uniform.  The  way  she  put  on  flesh 
was  marvellous,  and  one  could  almost  see  her 
fatten  from  day  to  day.  Within  ten  days  all  her 
pains,  neuralgia,  and  backache  had  gone,  and 
have  never  been  heard  of  since,  and  by  that  time 
we  had  also  got  rid  of  all  her  little  pillows  and 
other  invalid  appliances. 

"  It  may  be  of  interest,  as  showing  what  this 
system  is  capable  of,  if  I  copy  her  food  diary  on 
the  tenth  day  after  the  treatment  was  begun ; 
and  all  this,  this  bedridden  patient,  who  had 
lived  on  starvation  diet  for  twenty  years,  not 
only  consumed  with  relish,  but  perfectly  assim- 
ilated. 

"  Six  A.M. :  ten  ounces  of  raw  meat  soup.  7 
A.M. :  cup  of  black  cofifee.  8  a.m.  :  a  plate  of 
oatmeal  porridge,  with  a  gill  of  cream,  a  boiled 
Qgg^  three  slices  of  bread-and-butter,  and  cocoa. 
11  A.M. :  ten  ounces  of  milk.  2  p.m.  :  half  a 
pound  of  rump-steak,  potatoes,  cauliflower,  a 
savory  omelette,  and  ten  ounces  of  milk.  4 
P.M.  :    ten  ounces  of  milk  and  three  slices  of 


136  DIETETICS  AND    THERAPEUTICS. 

bread-and-butter.  6  p.m.  :  a  cup  of  gravy  soup. 
8  P.M. :  a  fried  sole,  roast  mutton  (three  large 
slices),  French  beans,  potatoes,  stewed  fruit  and 
cream,  and  ten  ounces  of  milk.  11  p.m.  :  ten 
ounces  of  raw  meat  soup. 

"  The  same  scale  of  diet  was  continued  during 
the  whole  treatment,  and,  from  first  to  last, 
never  produced  the  slightest  dyspeptic  symp- 
toms, and  was  consumed  with  relish  and  appe- 
tite. At  the  end  of  six  weeks  from  the  day  I 
first  saw  her  she  weighed  7  st.  8  lb., — that  is,  a 
gain  of  3  st.  1  lb.  It  will  suffice  to  indicate  her 
improvement  if  I  say  that  in  eight  weeks  from 
the  commencement  of  treatment  she  was  dressed, 
sitting  up  to  meals,  able  to  walk  up  and  down 
stairs  with  an  arm  and  a  stick,  and  had  also 
walked  in  the  same  way  in  the  park.  Consider- 
ing how  completely  atrophied  her  muscles  were 
from  twenty  years'  entire  disuse,  this  was  much 
more  than  I  had  ventured  to  hope.  She  has 
now  left  with  her  nurse  for  !N'atal,  and  I  have  no 
doubt  that  she  will  return  from  her  travels  with 
her  cure  perfected." 

"  Early  in  August  I  was  asked  to  see  a  lady, 
aged  thirty-sev^en,  with  the  following  historj^ : — 
'  As  a  girl  of  sixteen  she  had  a  severe  neuralgic 


DIETETICS  AND    THERAPEUTICS.  137 

illness,  extending  over  months :  excepting  that, 
she  seems  to  have  enjoyed  good  health  until  her 
marrias^e.  Soon  after  this  she  had  a  miscarriao:e, 
and  then  two  subsequent  pregnancies,  accom- 
panied by  albuminuria  and  the  birth  of  dead 
children.'  '  During  gestation  I  was  not  sur- 
prised at  all  sorts  of  nervous  affections,  attrib- 
uting them  to  uraemia.'  The  next  pregnancy 
terminated  in  the  birth  of  a  living  daughter, 
now  nearly  three  years  old ;  during  it  she  had 
'  curious  nervous  symptoms, — e.g.,  her  bed  flying 
away  with  her,  temporary  blindness,  and  vaso- 
motor disturbances.'  Subsequently  she  had  sev- 
eral severe  shocks  from  the  death  of  near  rela- 
tives, and  gradually  fell  into  the  condition  in 
which  she  was  when  I  was  consulted.  This  is 
difficult  to  describe,  but  it  was  one  of  confirmed 
illness  of  a  marked  neurotic  type.  Among 
other  phenomena  she  had  frequently-recurring 
attacks  of  fainting.  ^  These  were  not  attacks 
of  syncope,  but  of  such  general  derangement  of 
the  balance  of  the  circulation  that  cerebration 
was  interfered  with.  She  was  deaf  and  blind; 
her  face  often  flushed,  sometimes  deadly  cold; 
her  hands  clay-cold,  often  blue,  and  difficult  to 

warm  with  the  most  vigorous  friction.      These 

12* 


138  DIETETICS  AND   THERAPEUTICS. 

attacks  passed  off  in  from  twenty  minutes  to  a 
couple  of  hoars.'  Soon  '  the  attacks  became 
more  frequent,  with  the  reappearance  of  another 
old  symptom, — acute  tenderness  of  the  spine, 
especially  over  the  sacrum.  Then  came  frequent 
and  persistent  attacks  of  sciatica,  and  gradual 
loss  of  strength.'  About  this  time  there  appears 
to  have  been  some  uterine  lesion,  for  a  well- 
known  gynaecologist  went  down  to  the  country 
to  see  her.  Eventually  *  she  became  unable  to 
do  anj^thing  almost  for  herself,  for  the  nervous 
irritability  had  distressingly  increased.  To  touch 
her  bed,  the  ringing  of  a  bell,  sometimes  the 
sound  of  a  voice,  sunlight,  &c.,  affected  her  so 
as  to  make  her  almost  cry  out.'  '  If  she  stood 
up,  or  even  raised  her  hands  to  dress  her  hair, 
they  immediately  became  blue  and  deadly  cold, 
and  she  was  done  for.'  Then  followed  palpita- 
tions of  a  distressing  character,  with  loud  blow- 
ing murmur,  and  pulse  of  120  to  140,  for  which 
she  was  seen  by  an  eminent  physician,  who  diag- 
nosed them  to  be  caused  by  *  slight  ventricular 
asynchronism,  with  atonic  condition  of  the  car- 
diac as  well  as  of  all  other  muscles  of  the  body.' 
'  She  has  no  appetite  whatever.'  '  Any  attempt 
at  walking  brings  on  sciatica.      She  cannot  sit. 


DIETETICS  AND   THERAPEUTICS.  139 

because  the  tip  of  the  spine  is  so  sensitive ;  any 
pressure  on  it  makes  her  feel  faint.  She  cannot 
go  in  a  carriage,  because  it  jars  every  nerve  in 
her  body.  She  cannot  lie  on  her  back,  because 
her  whole  spine  is  so  tender.' 

"  When  consulted  about  this  lady,  I  gave  it  as 
my  opinion  that  any  attempt  at  cure  was  hope- 
less as  long  as  she  remained  in  the  country  house 
in  which  she  lived.  I  was  informed  that  it  was 
absolutely  impossible  to  get  her  away,  as  she 
could  not  bear  the  motion  of  any  carriage,  still 
less  of  a  railway,  without  the  most  acute  suffer- 
ing. Eventually  the  difficulty  was  got  over  by 
anjfisthetizing  her,  when  she  was  carried  on  a 
stretcher  to  the  nearest  railway  station,  and  then 
brought  over  two  hundred  miles  to  London, 
being  all  the  time  more  or  less  completely  under 
the  influence  of  the  anaesthetic,  administered  by 
her  medical  attendant,  who  accompanied  her.  I 
found  this  lady's  state  fully  justified  the  account 
given  of  her.  She  was  intensely  sensitive  to  all 
sounds  and  to  touch.  Merely  laying  the  hand 
on  the  bed  caused  her  to  shrink,  and  she  could 
not  bear  the  lightest  touch  of  the  fingers  on  her 
spine  or  any  part  near  it.  She  lay  in  a  darkened 
room  at  the  back  of  the  house,  to  be  away  from 


140  DIETETICS  AND    THERAPEUTICS. 

the  noise  of  the  streets,  wliicli  distressed  her 
much.  She  was  a  natural!}-  fine  and  highly-culti- 
vated woman,  greatly  emaciated,  with  a  dusky, 
sallow  complexion,  and  dark  rims  round  her 
eyes.  I  could  find  no  evidence  of  organic  dis- 
ease of  any  kind.  Whatever  lesion  of  the  uterine 
organs  had  previously  existed  had  disappeared, 
and  I  therefore  paid  no  attention  to  them. 
Within  a  week  I  had  the  patient  lying  in  a 
bright  sunlit  room  in  the  front  of  the  house, 
with  the  windows  open,  and  she  complained  no 
longer  of  the  noise.  Within  ten  days  the  whole 
spine  could  be  rubbed  freely  from  top  to  bottom, 
and  from  the  first  I  directed  the  masseuse  to  be 
relentless  in  her  manipulation  of  this  part  of  the 
body.  In  a  few  weeks  she  had  gained  flesh 
largely,  the  dusky  hue  of  her  complexion  had 
vanished,  and  she  looked  a  difterent  being.  The 
only  trouble  complained  of  was  sleeplessness, 
but  it  did  not  interfere  wdth  the  satisfactory 
progress  of  the  case,  and  no  hypnotic  was  given. 
After  the  first  few  days  we  had  no  return  of  the 
nerve-crises  which  in  the  country  had  formed  so 
characteristic  a  part  of  her  illness.  Her  hands 
and  feet  also,  at  first  of  a  remarkable  deadly 
coldness,  soon  became  warm,  and  remained  so. 


DIETETICS  AND    THERAPEUTICS.  141 

III  five  weeks  she  was  able  to  sit  up,  and  before 
the  fifth  week  of  treatment  was  completed  I  took 
her  out  for  a  drive  through  the  streets  in  an 
open  carriage  for  two  hours,  which  she  bore 
without  the  slightest  inconvenience,  and  the  re- 
sult of  which  she  thus  described  in  a  letter  the 
same  evening  : — '  I. never  enjoyed  anything  more 
in  my  life.  I  cannot  describe  my  delight  and 
my  astonishment  at  being  once  more  able  to 
drive  with  comfort.  My  back  has  given  me  no 
trouble,  and  I  was  not  really  tired.'  This  lady 
has  since  remained  perfectly  wxll,  and  I  need 
give  no  better  proof  of  this  than  stating  that  she 
has  started  with  her  husband  on  a  tour  round 
the  world,  via  India,  Japan,  and  San  Francisco, 
•  and  that  I  have  heard  from  her  that  she  is  thor- 
oughly enjoying  her  travels." 

"  The  last  example  with  which  I  shall  trespass 
on  your  patience  I  am  tempted  to  relate  be- 
cause it  is  one  of  the  most  remarkable  instances 
of  the  strange  and  multiform  phenomena  which 
neurotic  disease  may  present,  which  it  has  ever 
been  my  lot  to  witness.  The  case  must  be  well 
known  to  many  members  of  the  profession,  since 
there  is  scarcely  a  consultant  of  eminence  in  the 
metropolis  w^ho  has  not  seen  her  during  the  six- 


142  DIETETICS  AND    THERAPEUTICS. 

teen  years  her  illness  has  lasted,  besides  many 
of  the  leading  practitioners  in  the  numerous 
health-resorts  she  has  visited  in  the  vain  hope  of 
benefit.  My  first  acquaintance  with  this  case  is 
somewhat  curious.  About  two  months  before  I 
was  introduced  to  the  patient,  chancing  to  be 
walking  along  the  esplanade  at  Brighton  with  a 
medical  friend,  my  attention  was  directed  to  a 
remarkable  party  at  which  every  one  was  look- 
ing. The  chief  personage  in  it  was  a  lady  re- 
clining at  full  length  on  a  long  couch,  and  being 
dragged  along,  looking  the  picture  of  misery, 
emaciated  to  the  last  degree,  her  head  drawn 
back  almost  in  a  state  of  opisthotonos,  her  hands 
and  arms  clenched  and  contracted,  her  eyes  fixed 
and  staring  at  the  sky.  There  was  something  in 
the  whole  procession  that  struck  me  as  being 
typical  of  hj^steria,  and  I  laughingly  remarked, 
*  I  am  sure  I  could  cure  that  case  if  I  could  get 
her  into  my  hands.'  All  I  could  learn  at  the 
time  was  that  the  patient  came  down  to  Brighton 
every  autumn,  and  that  my  friend  had  seen  her 
dragged  along  in  the  same  way  for  ten  or  twelve 
years.  On  January  14  of  this  year,  I  was 
asked  to  meet  my  friend  Dr.  Behrend  in  consul- 
tation, and  at  once  recognized  the  patient  as  the 


DIETETICS  AND    THERAPEUTICS.  I43 

lady  whom  I  had  seen  at  Brighton.  It  would  be 
tedious  to  relate  all  the  neurotic  symptoms  this 
patient  had  exhibited  since  1864,  when  she  was 
first  attacked  with  paralysis  of  the  left  arm. 
Among  them — and  I  quote  these  from  the  full 
notes  furnished  by  Dr.  Behrend — were  complete 
paraplegia,  left  hemiplegia,  complete  hysterical 
amaurosis,  but  from  this  she  had  recovered  in 
1868.  For  all  these  years  she  had  been  prac- 
tically confined  to  her  bed  or  couch,  and  had 
not  passed  urine  spontaneously  for  sixteen  years. 
Among  other  symptoms,  I  find  noted  '  awful 
sufifering  in  spine,  head,  and  eyes,'  requiring  the 
use  of  chloral  and  morphia  in  large  doses.  '  For 
many  years  she  has  had  convulsive  attacks  of 
two  distinct  types,  which  are  obviously  of  the 
character  of  hystero-epilepsy.'  The  following 
are  the  brief  notes  of  the  condition  in  which  I 
found  her,  which  I  made  in  my  case-book  on  the 
day  of  my  first  visit.  '  I  found  the  patient  lying 
on  an  invalid  couch,  her  left  arm  paralyzed  and 
rigidly  contracted,  strapped  to  her  body  to  keep 
it  in  position.  She  w^as  groaning  loudly  at  inter- 
vals of  a  few  seconds,  from  severe  pain  in  her 
back.  When  I  attempted  to  shake  her  right 
hand,   she  begged  me  not  to  touch  her,  as  it 


144  DIETETICS  AND   THERAPEUTICS. 

would  throw  her  into  a  convulsion.  She  is  said 
to  have  had  epilepsy  as  a  child.  She  has  now 
many  times  daily,  frequently  as  often  as  twice  in 
an  hour,  both  during  the  day  and  night,  attacks  of 
sudden  and  absolute  unconsciousness,  from  which 
she  recovers  with  general  convulsive  movements 
of  the  face  and  body.  She  had  one  of  these 
during  my  visit,  and  it  had  all  the  appearance 
of  an  epileptic  paroxysm.  The  left  arm  and 
both  legs  are  paralyzed,  and  devoid  of  sensa- 
tion. She  takes  hardly  any  food,  and  is  terribly 
emaciated.  She  is  naturally  a  clever  woman, 
highly  educated,  but,  of  late,  her  memory  and 
intellectual  powers  are  said  to  be  failing.' 

"  It  was  determined  that  an  attempt  should  be 
made  to  cure  this  case,  and  she  was  removed  to 
the  Home  Hospital  in  Fitzroy  Square.  She  was 
so  ill,  and  shrieked  and  groaned  so  much,  on  the 
first  night  of  her  admission,  that  next  day  I  was 
told  that  no  one  in  the  house  had  been  able  to 
sleep,  and  I  was  informed  that  it  would  be  im- 
possible for  her  to  remain.  Between  3  p.m.  and 
11.30  P.M.  she  had  had  nine  violent  convulsive 
paroxysms  of  an  epileptiform  character,  lasting, 
on  an  average,  five  minutes.  At  11.30  she  be- 
came absolutely  unconscious,  and   remained  so 


DIETETICS  AND    THERAPEUTICS.  I45 

until  2.30  A.M.,  her  attendant  thinking  she  was 
dying.  IS'ext  day  she  was  quieter,  and  from  that 
time  her  progress  was  steady  and  uniform.  On 
the  fourth  day  she  passed  urine  spontaneously, 
and  the  catheter  was  never  again  used.  In  six 
weeks  she  was  out  driving  and  walking;  and 
within  two  months  she  went  on  a  sea-voyage  to 
the  Cape,  looking  and  feeling  perfectly  well. 
When  there,  her  nurse,  who  accompanied  her, 
had  a  severe  illness,  through  which  her  ex- 
patient  nursed  her  most  assiduously.  She  has 
since  remained,  and  is  at  this  moment,  in  rohust 
health,  joining  with  pleasure  in  society,  walking 
many  miles  daily,  and  without  a  trace  of  the  ill- 
nesses which  rendered  her  existence  a  burden  to 
herself  and  her  friends. 

''  In  conclusion,  I  may  remark  that  it  seems  to 
me  that  the  chief  value  of  this  systematic  treat- 
ment, which  is  capable  of  producing  such  re- 
markable results,  is  that  it  appeals,  not  to  one, 
but  many  influences  of  a  curative  character. 
Every  one  knew,  in  a  vague  sort  of  way,  that  if 
an  hysterical  patient  be  removed  from  her  mor- 
bid surroundings  a  great  step  towards  cure  is 
made.  Few,  however,  took  the  trouble  to  carry 
this  knowledge  into  practical  action ;  and  when 

G       k  13 


146  DIETETICS  AND    THERAPEUTICS. 

they  did  so  they  relied  on  this  alone,  combined 
with  moral  suasion.  JSTow,  I  am  thoroughly 
convinced  that  very  few  cases  of  hysteria  can  be 
preached  into  health.  Judicious  moral  manage- 
ment can  do  much ;  but  I  believe  that  very  few 
hysterical  women  are  conscious  impostors ;  and 
the  great  efficacy  of  the  Weir  Mitchell  method 
seems  to  me  to  depend  on  the  combination  of 
agencies  which,  by  restoring  to  a  healthy  state 
a  weakened  and  diseased  nervous  system,  cures 
the  patient  in  spite  of  herself." 

As  additional  illustrations  I  shall  now  state 
a  few  cases  of  my  own,  without  entering  into 
into  minute  details  of  treatment. 

The  following  case  is  reported  by  Dr.  John 
Keating,  who  watched  it  with  care  throughout : 

P.  D.,  male,  aet.  53,  after  more  than  thirty 
years  of  close  attention  to  business,  which  se- 
verely tried  both  mental  and  physical  endurance, 
found  himself,  in  January,  1877,  at  the  close  of 
some  months  of  gradually  increasing  feebleness, 
absolutely  unable  to  fulfil  his  usual  duties,  and 
the  most  alarming  symptoms  manifested  them- 
selves. There  was  a  remarkable  loss  of  nervous 
and  muscular  force;  his  limbs  refused  their 
support;  his  appetite  failed;  the  recollection  of 


DIETETICS  AND    THERAPEUTICS.  I47 

ordinary  phrases  involved  distinct  and  painful 
effort;  sleep  became  unattainable,  except  under 
the  influence  of  powerful  narcotics,  and  even 
that  brief  slumber  was  rendered  valueless  by  the 
incessant  convulsive  twitching  of  the  muscles. 

His  physician  prescribed  iron  and  strychnia; 
ordered  an  immediate  abandonment  of  all  busi- 
ness, and  instant  departure  to  a  point  where 
telegraph-wires  were  unknown  and  mails  infre- 
quent. He  went  at  once  to  the  Bahamas,  pass- 
ing a  month  in  that  delicious  climate  in  absolute 
inaction;  more  than  another  month  was  con- 
sumed in  slowly  returning;  but,  though  some 
flesh  had  been  gained,  there  was  only  a  trifling 
improvement  in  the  nervous  condition. 

May  1, 1877,  Dr.  Mitchell  examined  Mr.  P.  D. 
The  patient  was  sallow  and  emaciated,  and 
coughed  every  few  moments.  He  had  night- 
sweats,  nervous  twitching,  and  slight  dulness  on 
percussion  at  the  apex  of  the  right  lung,  with 
prolonged  expiration  and  roughened  inspiration, 
and  some  increase  of  vocal  resonance. 

Mr.  P.  D.  was  allowed  to  be  out  of  bed  once 
a  day  four  hours,  and  to  spend  one  hour  at  his 
place  of  business.    The  treatment  was  as  follows : 

At  6  A.M.,  a  tumbler  of  strong,  hot  beef- tea, 
made  from  the  Australian  extract. 


148  DIETETICS  AND    THERAPEUTICS. 

At  8  A.M.,  half  a  tumbler  of  iron-water,  and 
breakfast,  consisting  of  fruit,  steak,  potatoes, 
coffee,  and  a  goblet  of  milk. 

At  8.30  A.M.,  a  goblet  of  milk  mixed  with  a 
dessertspoonful  of  Loefland's  extract  of  malt, 
with  six  grains  of  citrate  of  iron  and  quinine. 

At  10  o'clock  Dr.  Keating  administered  the 
electricity. 

At  12  o'clock  Mr.  P.  D.  might  be  dressed, 
making  as  little  personal  effort  as  possible.  The 
second  goblet  of  milk  and  malt  was  administered, 
and  a  carriage  took  him  to  his  office,  where  he 
might  remain  till  two  o'clock,  when  the  carriage 
brought  him  for  dinner,  preceded  by  half  a 
tumbler  of  iron-water.  All  walking  was  for- 
bidden. 

After  dinner  (which  included  a  goblet  of  milk) 
the  third  goblet  of  milk  and  malt  was  swallowed ; 
then  a  short  drive  might  be  taken,  but  by  four 
o'clock  the  patient  must  be  undressed  and  in 
bed. 

At  6  P.M.  the  third  dose  of  iron-water  pre- 
sented itself,  and  a  light  supper  of  fruit,  bread- 
and-butter,  and  cream,  followed  by  the  fourth 
goblet  of  milk  and  malt.  Two  quarts  of  milk 
were  thus  swallowed  every  day  in  addition  to  all 
other  food. 


DIETETICS  AND    THERAPEUTICS.  I49 

At  9  P.M.,  massage  one  hour,  with  cocoa-oil, 
followed  by  beef-soup,  four  ounces. 

At  the  fourth  week  the  soup  was  given  up ; 
dialyzed  iron  was  substituted  for  all  other  forms. 
June  4,  electricity  was  given  up.  The  malt  was 
continued  until  June  20. 

May  6,  Mr.  D.  weighed  in  heavy  winter  dress 
one  hundred  and  twenty-five  pounds;  June  20, 
in  the  lightest  summer  garb,  he  weighed  one 
hundred  and  thirty-three  pounds ;  in  August  his 
weight  rose  to  one  hundred  and  forty  pounds, 
and  he  has  continued  to  gain.  When  last  I  saw 
him,  a  year  later,  he  was  strong  and  well,  had 
no  cough,  and  had  ceased  to  be  what  he  had 
been  for  years — a  delicate  man. 

I  am  indebted  to  Professor  Goodell  for  the  fol- 
lowing case,  which  I  never  saw,  but  which  was 
carried  on  with  every  detail  of  my  treatment. 
As  the  testimony  of  an  admirable  observer,  it 
is  valuable  evidence.  Professor  Goodell  writes 
as  follows : 

"  Some  four  years  ago,  Mrs.  Y.,  a  very  highly 
intelligent  lady,  from  a  neighboring  city,  came 
to  consult  me.  She  suiFered  dreadfully  at  each 
monthly  period,  and  had  constant  ovarian  pains 
and  a  wearying  backache,  which  kept  her  on  a 

13* 


150  DIETETICS  AND   THERAPEUTICS, 

lounge  most  of  the  day.  She  was  also  barren, 
and  altogether  in  a  pitiable  condition.  After  a 
two  months'  treatment  she  returned  home  very 
much  better,  and  soon  after  conceived.  As 
pregnancy  advanced,  many  of  her  old  symptoms 
came  back,  but  it  w^as  hoped  that  maternity 
would  rid  her  of  them.  The  shock  of  the  labor, 
however,  proved  too  great  for  her  already  shat- 
tered nervous  system.  She  became  far  more 
wretched  than  before,  and  again  sought  my  ad- 
vice. 

*'  At  this  time  I  found  all  her  old  pains  and 
aches  running  riot.  She  got  no  relief  from 
them  night  or  day  without  large  doses  of  chloral. 
The  slightest  exertion,  such  as  sewing,  writing, 
and  reading  for  a  few  minutes,  greatly  wearied 
her.  Even  the  simple  mental  eifort  of  casting 
up  the  weekly  housekeeping  expenses  of  a  very 
small  household  upset  her,  and  she  had  to  give 
it  up.  The  act  of  walking  one  of  our  blocks, 
or  of  going  down  a  short  flight  of  stairs,  or  of 
riding  for  an  hour  in  a  well-padded  carriage, 
gave  her  such  '  unspeakable  agony' — to  use  her 
own  w^ords — that  she  would  have  an  hysterical 
attack  of  screams  and  tears.  So  emotional  had 
this   constant   nerve-strain    made   her   that    she 


DIETETICS  AND    THERAPEUTICS.  151 

could  not  sustain  an  ordinary  conversation  with- 
out giving  way  to  tears.  Much  of  her  time  was 
spent  in  bed :  in  fact,  she  was  practically  bed- 
ridden. 

"  I  tried  in  vain  to  wean  her  from  her  ano- 
dynes, and  failed  altogether  in  doing  her  any 
good,  although  many  remedies  were  resorted 
to,  and  various  modes  of  treatment  adopted. 
Finally,  in  sheer  despair,  I  put  her  to  bed,  and 
began  your  treatment  of  rest,  with  electricity, 
massage,  and  frequent  feeding.  The  first  trace 
of  improvement  showed  itself  in  a  greater  self- 
control,  and  in  a  lessening  of  her  aches  and 
pains.  Next,  smaller  doses  of  the  anodyne  were 
needed,  until  it  was  wholly  withheld.  Then  she 
began  to  pick  up  an  appetite,  which,  towards 
the  close  of  the  treatment,  became  so  keen  that, 
between  three  good  meals  every  day,  she  drank 
several  goblets  of  milk  and  of  beef-tea.  At  the 
outset  I  had  stipulated  for  six  weeks  of  this 
treatment,  and  it  was  with  reluctance  that  my 
patient  yielded  to  my  wish.  But  when  the  time 
was  up  she  had  become  so  impressed  with  the 
wonderful  benefits  she  had  received  and  was 
receiving,  that  she  begged  to  have  the  treatment 
continued  for  two  weeks  more.     At  the  end  of 


152  DIETETICS  AND   THERAPEUTICS. 

that  time  she  had  gained  at  least  thirty  pounds 
in  weight,  and  had  lost  every  pain  and  ache. 
Her  night- terrors,  which  I  forgot  to  mention  as 
one  of  her  distressing  symptoms,  had  wholly 
disappeared,  and  she  could  sleep  from  nine  to 
ten  hours  at  a  stretch.  I  now  sent  her  into  the 
country,  where  she  is  continuing  to  mend,  and 
is  astonishing  her  friends  by  her  scrambles  up 
and  down  the  steep  hills. 

"  Such  were  the  salient  features  of  this  case ; 
and  I  can  assure  you  that  I  was  as  much  im- 
pressed by  the  happy  results  of  the  treatment  as 
were  a  host  of  anxious  and  doubting  friends. 
"  Very  faithfully  yours, 

"  Wm.  Goodell." 

Miss  C,  an  interesting  woman,  set.  26,  at  the 
age  of  20  passed  through  a  grave  trial  in  the 
shape  of  nursing  her  mother  through  a  typhoid 
fever.  Soon  after,  a  series  of  calamities  deprived 
her  of  fortune,  and  she  became,  for  support,  a 
clerk,  and  did  for  two  years  eight  hours'  work 
daily.  Under  these  successive  strains  her  natu- 
rally sturdy  health  gave  way.  First  came  pain 
in  the  back,  then  growing  paleness,  loss  of  flesh, 
and  unending  sense  of  tire.     Her  work,  which 


DIETETICS  AND    THERAPEUTICS.  I53 

was  a  necessity,  was  of  course  kept  up,  steadily 
at  first,  but  was  soon  interfered  with  by  increase 
of  the  menstrual  flow,  with  unusual  pain  and 
persistent  ovarian  tenderness.  Yery  soon  she 
began  to  drop  her  work  for  a  day  at  a  time. 
Then  came  an  increasing  asthenopia,  with  even- 
ing headaches,  until  her  temper  changed  and 
became  capricious  and  irritable.  When  I  saw 
her,  she  had  been  forced  to  abandon  all  labor,  and 
had  been  treated  by  an  accomplished  gynsecol- 
ogist,  and  was  said  to  be  cured  of  a  prolapsus 
uteri  and  of  extensive  ulceration,  despite  which 
relief  she  gained  nothing  in  vigor  and  endurance 
and  got  back  neither  color  nor  flesh. 

She  went  to  bed  December  10,  and  rose  for 
the  first  time  February  4;  having  gained  twenty- 
nine  pounds.  She  went  to  bed  pale,  and  got 
up  actually  ruddy.  In  a  month  she  returned 
to  her  work  again,  and  has  remained  ever  since 
in  health  which  enables  her,  as  she  writes  me, 
"  to  enjoy  work,  and  to  do  with  myself  what  I 
like." 

Two  years  ago.  Miss  L.,  set.  26,  came  to  me 
with  the  following  history.  At  the  age  of  20  she 
had  a  fall,  and  began  in  a  week  or  two  to  have 
an  irritable  spine.     Then,  after  a  few  months,  a 


154  DIETETICS  AND    THERAPEUTICS. 

physician  advised  rest,  to  which  she  took  only 
too  kindly,  and  in  a  year  from  the  time  of  her 
accident  she  was  rarely  out  of  bed.  Surrounded 
by  highly  sympathetic  relatives,  to  whom  chronic 
illness  was  somewhat  novel,  she  speedily  devel- 
oped, with  their  tender  aid,  hypersesthetic  states 
of  the  eye  and  ear,  so  that  her  nurses  crept 
about  in  a  darkened  room,  the  piano  was  si- 
lenced, and  the  children  kept  quiet.  Bv  slow 
degrees  a  whole  household  passed  under  the 
selfish  despotism  of  an  hysterical  girl.  Intense 
constipation,  anorexia,  and  alternate  states  of 
dysuria,  anuria,  and  polyuria  followed,  and  be- 
fore long  her  sister  began  to  fail  in  health,  owing 
to  the  incessant  exactions  to  which  she  too  will- 
ingly yielded.  This  alarmed  a  brother,  who  in- 
sisted upon  a  change  of  treatment,  and  after 
some  months  she  w^as  brought  on  a  couch  to  this 
city. 

At  the  time  I  first  saw  her,  she  took  thirty 
grains  of  chloral  every  night  and  three  hypo- 
dermic injections  of  one-half  grain  of  morphia 
daily.  As  to  food,  she  took  next  to  none,  and 
I  could  only  guess  her  weight  at  about  ninety 
pounds.  She  was  in  height  five  feet  two  and  a 
half  inches,  and  very  sallow,  with  pale  lips,  and 


DIETETICS  AND    THERAPEUTICS.  I55 

the  large,  indented  tongue  of  ansemia.  I  made 
the  most  careful  search  for  signs  of  organic  mis- 
chief, and,  finding  none,  I  began  my  treatment 
as  usual  with  milk,  and  added  massage  and  elec- 
tricity without  waiting.  Her  digestion  seemed  so 
good  that  I  gave  lactate  of  iron  in  twenty-grain 
doses  from  the  third  day,  and  also  the  aloes  pill 
thrice  a  day.  It  is  perhaps  needless  to  state  that 
I  isolated  her  with  a  nurse  she  had  never  seen 
before,  and  that  for  seven  weeks  she  saw  no  one 
else  save  myself  and  the  attendants.  The  full 
schedule  of  diet  was  reached  at  the  end  of  a 
fortnight,  but  the  chloral  and  morphia  were 
given  up  at  the  second  day.  She  slept  well  the 
fourth  night,  and,  save  that  she  had  twice  a  slight 
return  of  polyuria,  went  on  without  a  single 
drawback.  In  two  months  she  was  afoot  and 
weighed  one  hundred  and  twenty-one  pounds. 
Her  change  in  tint,  flesh,  and  expression  was 
so  remarkable  that  the  process  of  repair  might 
well  have  been  called  a  renewal  of  life. 

She  went  home  changed  no  less  morally  than 
physically,  and  resumed  her  place  in  the  family 
circle  and  in  social  life,  a  healthy  and  well-cured 
woman. 

I  might  multiply  these  histories  almost  end- 


156  DIETETICS  AND    THERAPEUTICS. 

lessly.  In  some  cases  I  have  cured  without  fat- 
tening; in  others,  though  rarely,  the  mental 
habits  formed  through  years  of  illness  have  been 
too  deeply  ingrained  for  change,  and  I  have  seen 
the  patient  get  up  fat  and  well  only  to  relapse  on 
some  slight  occasion. 

The  intense  persistency  with  which  some 
women  study  and  dwell  upon  their  symptoms  is 
often  the  great  difficulty.  Even  a  slight  physi- 
cal annoyance  becomes  for  one  of  these  unhap- 
pily-constituted natures  a  grave  and  almost  in- 
eradicable trouble,  owing  to  the  habit  of  self- 
study. 

Miss  P.,  set.  29,  weight  one  hundred  and  eleven 
pounds,  height  five  feet  four  inches,  dark-skinned, 
sallow,  and  covered  with  the  acne  of  bromidism, 
consulted  me  last  year.  She  had  had  one  at- 
tack which  was  considered  to  have  been  epi- 
leptic, and  which  was  probably  hysterical,  but 
on  this  matter  she  dwelt  with  incessant  terror, 
which  was  fostered  by  the  tender  care  of  a  near 
relative,  who  left  her  neither  by  night  nor  day. 
Vague  neuralgic  aches  in  the  limbs,  with  con- 
stant weariness,  asthenopia,  anaemia,  loss  of  ap- 
petite, and  loss  of  flesh,  followed.  Then  came 
spinal  pain  and  irregular  menstruation,  a  long 


DIETETICS  AND    THERAPEUTICS.  I57 

course  of  local  cauterizations  of  the  womb,  spinal 
braces,  and  endless  tonics  and  narcotics. 

I  broke  up  the  association  which  had  nearly 
been  fatal  to  both  women,  and,  confidently  prom- 
ising a  cure,  carried  out  my  treatment  in  full. 
In  three  months  she  went  home  well  and  happy, 
greatly  improved  in  looks,  her  skin  clear,  her 
functions  regular,  and  weighing  one  hundred 
and  thirty-six  pounds. 

It  is  vain  to  repeat  the  relation  of  such  cases, 
and  impossible  to  put  on  paper  the  means  for 
deciding — what  is  so  large  a  part  of  success  in 
treatment — the  moral  methods  of  obtaining  con- 
fidence and  insuring  a  childlike  acquiescence  in 
every  needed  measure. 

Another  class  of  cases  will,  however,  bear 
some  further  illustration.  We  meet  with  women 
who  are  healthy  in  mind,  but  who  have  some 
chronic  pain  or  some  definite  maladj^  which  does 
not  get  well,  either  because  the  usual  tonics  fail, 
or  because  their  occupations  in  life  keep  them 
always  in  a  state  of  exhaustion.  K  by  rest  we 
slow  the  machinery,  and  by  massage  and  elec- 
tricity deprive  rest  of  its  evils,  we  can  often 
obtain  cures  which  are  to  be  had  in  no  other 
way.  This  is  true  of  many  uterine  and  of  some 
other  disorders. 

14 


158  DIETETICS  AND    THERAPEUTICS. 

Miss  B.,  set.  37,  height  five  feet  five  inches, 
weight  one  hundred  and  fifteen  pounds,  a  school- 
teacher, without  any  notable  organic  disease,  had 
a  severe  fall,  owing  to  an  accident  while  driving. 
A  slight  swelling  in  the  hurt  lumbar  region  was 
followed  by  pain,  which  became  intense  when 
she  walked  any  distance.  Loss  of  color,  flesh, 
and  appetite  ensued,  and,  after  much  treatment, 
she  consulted  me,  a  year  and  a  half  ago.  I 
could  find  nothing  beyond  soreness  on  deep 
pressure,  and  she  was  anything  but  hysterical 
or  emotional. 

Two  months'  rest  with  the  usual  treatment 
brought  her  weight  up  to  one  hundred  and 
thirty-eight  pounds,  and  she  has  been  able  ever 
since  to  do  her  usual  work,  and  to  walk  when 
and  where  and  as  far  as  she  wished. 

A  year  ago  I  treated  with  some  reluctance  a 
lady  who  had  extensive  bronchitis  and  a  slight 
albuminuria.  This  woman  was  a  mere  skeleton, 
with  every  function  out  of  order.  I  undertook 
her  case  with  the  utmost  distrust,  but  I  had  the 
pleasure  to  find  her  fattening  and  reddening  like 
others.  Her  cough  left  her,  the  albumen  disap- 
peared, and  she  became  well  enough  to  walk  and 


DIETETICS  AND    THERAPEUTICS.  I59 

drive;  when  a  sudden  congestion  of  the  kidneys 
destroyed  her  in  forty-eight  hours. 

I  have  ventured,  without  much  hope,  to  treat 
three  cases  of  phthisis  in  the  same  manner. 
There  are  cases  of  this  nature  in  which  exercise 
wearies ;  there  are  others  which  we  cannot,  for 
various  reasons,  send  away  to  more  genial  cli- 
mates; and  in  such  instances  we  are  driven  to 
stand  by  and,  with  no  more  hope  than  oil  and 
tonics  give,  merely  watch  the  slow  decline  of  our 
patients.  I  believe  that  sometimes,  and  especially 
in  the  very  earliest  stages  of  consumption,  my 
treatment  will  save  a  small  percentage  of  such 
people;  but  as  yet  I  only  venture  to  make  the 
suggestion,  and  wish  distinctly  to  state  that  my 
experience  in  this  form  of  its  usefulness  is 
limited. 

One  of  the  cases  treated  got  well  and  remained 
well.  There  w^as  every  evidence  of  pulmonary 
trouble. 

A  second  improved  enormously  in  all  re- 
spects, but  relapsed  hopelessly,  owing  to  large 
and  repeated  bleeding  from  piles  and  rectal 
fissure. 

The  third,  a  male,  set.  24,  was  treated  by  rest 
and  massage  without  electricity,  and  improved 


160  DIETETICS  AND    THERAPEUTICS. 

SO  as  to  resume  his  work.  He  still  has  slight 
cough,  and  has  to  be  careful,  and  there  are,  as 
jet,  distinct  evidences  of  inactive  disease  at  the 
summit  of  the  left  lung. 

I  could  relate  cases  of  gain  in  flesh  without 
manifest  relief.  As  I  have  said,  these  are  rare; 
but  it  is  less  uncommon  to  see  great  relief  with- 
out improvement  in  weight  at  all,  or  until  the 
patient  is  up  and  afoot  for  some  weeks ;  and  I 
could  also  state  several  cases  in  which  a  repeti- 
tion of  the  treatment  won  a  final  and  complete 
success  after  the  first  efibrt  at  cure  had  failed 
or  but  partially  succeeded ;  and  of  this,  I  believe, 
Professor  Goodell  has  seen  several  examples. 

I  have  mentioned  more  than  once  the  sin- 
gular return  of  menstruation  under  this  treat- 
ment, and  as  examples  I  add  a  brief  list  of  some 
notable  instances. 

Mrs.  X.,  set.  29,  no  menstruation  for  five  years ; 
return  of  menstruation  at  thirtieth  day  of  treat- 
ment; continued  regularly  ever  since  during 
three  years. 

Mrs.  C,  set.  42,  eight  years  without  menstru- 
ation;  return  at  fourteenth  day  of  treatment; 
now  regular  during  five  months. 

Miss    C,  set.    22,  no   menstruation    for   eight 


DIETETICS  AND    THERAPEUTICS.  \Q\ 

months ;  return  at  close  of  sixtieth  day  of  treat- 
ment ;  regular  now  for  four  months. 

Miss  A.,  set.  26,  irregular;  missing  for  two  or 
three  months,  and  then  menstruating  irregularly 
for  two  or  three  months.  No  flow  for  two 
months.  Menstruated  at  nineteenth  day  of 
treatment,  and  regular  during  thirteen  months 
ever  since. 

I  had  at  one  time  intended  to  give,  in  the  first 
edition  of  this  work,  a  summary  of  all  my  cases, 
with  the  results ;  but  what  is  easy  to  do  in  defi- 
nite maladies  like  typhoid  fever  becomes  hard 
in  cases  such  as  I  here  relate.  In  fevers  the 
statistics  are  simple, — patients  die  or  get  well; 
but  in  cases  of  nervous  exhaustion,  so  called,  it 
is  impossible  to  state  accurately  the  number  of 
partial  recoveries,  or,  at  least,  to  define  usefully 
the  degrees  of  gain.  For  these  reasons  I  have 
not  attempted  to  furnish  full  statistics  of  the 
large  number  of  cases  I  have  treated. 

In  the  debate  before  the  British  Medical  Asso- 
ciation the  question  of  the  permanence  of  cures 
by  this  method  was  the  subject  of  discussion. 
I  have  lately  been  at  some  pains  to  learn  the 
fate  of  many  of  my  earlier  cases,  and  can  say 
with  certainty  that  every  case  then  treated  was 

I  14* 


162  DIETETICS  AND   THERAPEUTICS. 

selected  because  all  else  had  failed,  and  that  I 
find  relapses  into  the  state  they  were  in  when 
brought  to  me  to  have  been  very  uncommon.  A 
vast  proportion  have  remained  in  useful  health, 
and  a  small  number  have  lost  a  part  of  their 
gains. 

I  said  in  my  first  edition  that  I  did  not  doubt 
that  the  statements  I  made  would  give  rise  in 
some  minds  to  that  distrust  which  the  relation 
of  remarkable  cures  so  naturally  excites;  and 
this  I  cannot  blame.  Every  physician  can  re- 
call in  his  own  practice  such  cases  as  I  have 
described,  and  every  medical  man  of  large  ex- 
perience knoAvs  that  many  of  these  women  are 
to  him  sources  of  anxiety  or  of  therapeutic 
despair  so  deep  that  after  a  time  he  gets  to 
think  of  them  as  destined  irredeemably  to  a 
life  of  imperfect  health,  and  finds  it  hard  to  be- 
lieve that  any  method  of  treatment  can  possibly 
achieve  a  rescue. 

I  am  fortunate  now  in  having  been  able  to 
show  that  in  other  hands  than  my  own,  both 
here  and  abroad,  this  treatment  has  so  thor- 
oughly justified  itself  as  to  need  no  further  de- 
fence or  apology  from  its  author.  It  has  grati- 
fied  me   also  to   learn  that  in   many  instances 


DIETETICS  AND   THERAPEUTICS.  Ig3 

country  physicians,  remote  from  the  resources 
of  great  cities,  have  been  able  to  make  it  avail- 
able. As  I  have  already  said,  I  am  now  more 
fearful  that  it  will  be  misused,  or  used  where  it 
is  not  needed,  than  that  it  will  not  be  used  ;  and, 
with  this  word  of  caution,  I  leave  it  again  to  the 
judgment  of  time  and  my  profession. 


INDEX. 


Acne,  caused  by  massage,  75. 
Alcoholism  producing  fat,  23. 
American   race-peculiarities,   17, 

21. 
Anaemia,  fatigue  in,  64. 
Anaemic  obesity,  107. 
Asthenopia,  60,  126. 

Banting,  objections  to,  105. 
Bathing,  effects  of,  59. 
Bleeding,  causing  increase  of  fat, 

24. 
Bowditch  on  weight  at  different 

ages,  17,  23. 

Cases : 

anaemic  obesity,  108,  110. 
chloral  habit,  131. 
hysteria,  133,  149,  153,  156. 
hysteria    and    neurasthenia, 

136. 
hysterical  paralysis,  126. 
hystero-epilepsy,  141. 
neurasthenia,  121,  158. 
neurasthenia  and  pulmonary 

disease,  146. 
pulmonary  disease,  159. 
simulated  paralysis,  68. 
uterine  disease,  152. 
uterine   disease  and   chloral 
habit,  130. 
Chorea,  33. 

Constipation  caused  by  milk  diet, 
101. 


Corpulence,  Harvey  on,  105. 

Dietetics,  97. 

Electricity,  86. 

in  constipation,  87. 

mode  of  using,  86. 

rise  of  temperature  from,  88. 

when  needed,  55. 

Fat  in  alcoholism,  23. 

in  its  relation  to  health,  16. 

increased  by  bleeding,  24. 

mode  of  accumulation  of,  27. 

varieties  of,  25. 
Food,  amount  of,  114. 

Gymnastics,  Swedish,  77. 

Harvey  on  corpulence,  106. 

Hysteria,  vide  Cases. 

Introduction,  9. 
Iron,  use  of,  118. 

Jackson  on  rest,  53. 

Earell  on  milk-treatment,  45,  97, 

99. 

Letheby  on  fattening  stock,  26. 

Malt  extract,  114. 
Malt,  Japanese  extract  of,  118. 
165 


166 


INDEX. 


Menstruation,  effect  of  rest   on, 

160. 
Massage,  71. 

amount  of,  76. 

business    of    the    blind     in 

Japan,  72. 
causing  acne,  75. 
effect  on  temperature,  78. 
effect  on  tissue-change,  80. 
in  Sandwich  Islands,  72. 
mode  of,  73. 
why  useful,  83. 
Milk  diet,  97. 

constipation  caused  by,  101. 
disappearance   of    uric   acid 

during  use  of,  102. 
effects  on  urinary  pigments 

of,  102. 
general  effects,  101. 
in  obesity,  lOi. 
in  obesity  with  anaemia,  107, 

108. 
Karell  on,  45,  97,  99. 
precautions  in  using,  99. 
sleepiness  from,  101. 
stools  during  use  of,  101,  103. 
Morphia    habit,  treated    by  rest, 
(.to.,  113. 

Neurasthenia,  hysterical,  111. 

treatment  of,  111. 
Nurse,  choice  of,  50. 

Oleum  morrhuae,  116. 
Obesity  with  anaemia,  107. 
milk  diet  in,  104. 

Peculiarities   of  American    race, 
17,  21. 


Permanence  of  relief  after  treat- 
ment, 162. 
Phthisis,  gain  of  weight  in,  35. 

Pollock  on,  35. 
Playfair     on     nerve-prostration, 
126. 
quotations  from,  126  et  seq. 

Quetelet   on   gain    of  weight   at 
different  ages,  17. 

Rest,  52. 

definition  of,  57. 
effects  of,  62,  65. 
effects   of,  on   menstruation, 

160. 
in  neuralgia,  53. 
in  s-pinal  disease,  53. 
Jackson  on,  53. 
mental,  63. 

mode  of  terminating,  70. 
moral  uses  of,  61. 
reasons  for,  52,  62. 

Seclusion,  47. 

Soup,  raw,  mode  of  making,  115. 

Stimulus,  117. 

Therapeutics,  97. 
Treatment,  season  for,  50. 

selection  of  cases  for,  33. 

Urinary    pigments,   changes    in 
during  milk  diet,  102. 

Weight    at  different  ages.   Bow- 
ditch  on,  17,  23. 
Quetelet  on,  17. 
Weight,  gain  or  loss  of.  14. 

loss  of,  relation  to  anaemia, 
15. 


THE    END. 


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